Provider Demographics
NPI:1023249174
Name:CISNEROS, JOSE GOMEZ (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GOMEZ
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3140 N 35TH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-5270
Mailing Address - Country:US
Mailing Address - Phone:023-536-6566
Mailing Address - Fax:602-442-2065
Practice Address - Street 1:3140 N 35TH AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5270
Practice Address - Country:US
Practice Address - Phone:602-353-6656
Practice Address - Fax:602-442-2065
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ50002207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology