Provider Demographics
NPI:1891993515
Name:CISNEROS CENTER OF OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:CISNEROS CENTER OF OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-252-1247
Mailing Address - Street 1:9981 WASHINGTON ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2169
Mailing Address - Country:US
Mailing Address - Phone:303-252-1247
Mailing Address - Fax:303-569-6078
Practice Address - Street 1:9981 WASHINGTON ST
Practice Address - Street 2:SUITE 22
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2169
Practice Address - Country:US
Practice Address - Phone:303-252-1247
Practice Address - Fax:303-569-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86856723Medicaid
COC804597Medicare PIN