Provider Demographics
NPI:1831340710
Name:CISNEROS, MARIA ANGELES (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELES
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 CALYPSO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4979
Mailing Address - Country:US
Mailing Address - Phone:407-247-4768
Mailing Address - Fax:
Practice Address - Street 1:6419 CALYPSO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4979
Practice Address - Country:US
Practice Address - Phone:407-247-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist