Provider Demographics
NPI:1831622661
Name:TISCARENO, CYNTHIA (R1247010317)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TISCARENO
Suffix:
Gender:F
Credentials:R1247010317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20725 ROCKCROFT DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5343
Mailing Address - Country:US
Mailing Address - Phone:424-268-9858
Mailing Address - Fax:
Practice Address - Street 1:4326 AVOCA AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-5121
Practice Address - Country:US
Practice Address - Phone:661-436-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)