Provider Demographics
NPI:1760200331
Name:CISNEROS, MARIANNA GIOCONDA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:GIOCONDA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7521
Mailing Address - Country:US
Mailing Address - Phone:619-894-4004
Mailing Address - Fax:619-894-4004
Practice Address - Street 1:4138 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7521
Practice Address - Country:US
Practice Address - Phone:619-894-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner