Provider Demographics
NPI:1649085432
Name:CISNEROS, JESSICA A (MA/ MANAGER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MA/ MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 ATLANTIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3529
Mailing Address - Country:US
Mailing Address - Phone:562-633-1765
Mailing Address - Fax:562-633-7853
Practice Address - Street 1:3939 ATLANTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3529
Practice Address - Country:US
Practice Address - Phone:562-633-1765
Practice Address - Fax:562-633-7853
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000000000000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical