Provider Demographics
NPI:1851963631
Name:CISNEROS, SHILA CHANTEL
Entity Type:Individual
Prefix:
First Name:SHILA
Middle Name:CHANTEL
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 1:27411 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-1708
Mailing Address - Country:US
Mailing Address - Phone:559-507-2748
Mailing Address - Fax:
Practice Address - Street 1:27411 ELLIS ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-1708
Practice Address - Country:US
Practice Address - Phone:559-507-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician