Provider Demographics
NPI:1780458620
Name:CISNEROS, JESUS ALEJANDRO
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ALEJANDRO
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7387 NICHOLAS PL
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-9255
Mailing Address - Country:US
Mailing Address - Phone:209-635-7063
Mailing Address - Fax:
Practice Address - Street 1:7387 NICHOLAS PL
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:CA
Practice Address - Zip Code:95388-9255
Practice Address - Country:US
Practice Address - Phone:209-635-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician