Provider Demographics
NPI:1730300468
Name:CISNEROS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SPLENDID WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-9544
Mailing Address - Country:US
Mailing Address - Phone:916-261-1863
Mailing Address - Fax:510-376-0759
Practice Address - Street 1:6615 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4601
Practice Address - Country:US
Practice Address - Phone:916-681-6300
Practice Address - Fax:530-376-0759
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist