Provider Demographics
NPI:1356576342
Name:CISNEROS-VENTURA, TANIA GABRIELA (MFTI)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:GABRIELA
Last Name:CISNEROS-VENTURA
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MRS
Other - First Name:TANIA
Other - Middle Name:GABRIELA
Other - Last Name:CISNEROS-VENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT #109684
Mailing Address - Street 1:35 E. 10TH ST. SUITE L
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376
Mailing Address - Country:US
Mailing Address - Phone:209-637-0555
Mailing Address - Fax:209-597-5551
Practice Address - Street 1:35 E. 10TH ST. SUITE L
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-637-0555
Practice Address - Fax:209-597-5551
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist