Provider Demographics
NPI:1881683159
Name:CISNEROS, LAURA E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:CISNEROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1719 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8912
Mailing Address - Country:US
Mailing Address - Phone:956-364-2131
Mailing Address - Fax:956-364-2141
Practice Address - Street 1:1719 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8912
Practice Address - Country:US
Practice Address - Phone:956-364-2131
Practice Address - Fax:956-364-2141
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4352207RH0003X
IL0036097143207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1881683159OtherBLUECROSS BLUESHIELD OF TEXAS
MI0N67740OtherMEDICARE GROUP #
TX208963302Medicaid
TXP00851107OtherRAILROAD MEDICARE
TX387618YP8UMedicare PIN
TX1881683159OtherBLUECROSS BLUESHIELD OF TEXAS
TX8L22076Medicare PIN