Provider Demographics
NPI:1922656636
Name:CISNEROS, MONICA JASMINE I (N/A)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JASMINE
Last Name:CISNEROS
Suffix:I
Gender:F
Credentials:N/A
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:JASMINE
Other - Last Name:CISNEROS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1600 BUCHANAN RD APT 14
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4241
Mailing Address - Country:US
Mailing Address - Phone:925-529-2183
Mailing Address - Fax:
Practice Address - Street 1:1600 BUCHANAN RD APT 14
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4241
Practice Address - Country:US
Practice Address - Phone:925-529-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6555555555Medicaid