Provider Demographics
NPI:1396463295
Name:CISNEROS, CELESTE Z
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:Z
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 N MESA ST STE 508
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4427
Mailing Address - Country:US
Mailing Address - Phone:915-266-3174
Mailing Address - Fax:915-205-7878
Practice Address - Street 1:6633 N MESA ST STE 508
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4427
Practice Address - Country:US
Practice Address - Phone:915-266-3174
Practice Address - Fax:915-205-7878
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089047363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care