1881683159 NPI number — DR. LAURA E CISNEROS MD

Table of content: DR. LAURA E CISNEROS MD (NPI 1881683159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881683159 NPI number — DR. LAURA E CISNEROS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CISNEROS
Provider First Name:
LAURA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CISNEROS
Provider Other First Name:
LAURA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881683159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1719 TREASURE HILLS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-364-2131
Provider Business Mailing Address Fax Number:
956-364-2141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1719 TREASURE HILLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-364-2131
Provider Business Practice Location Address Fax Number:
956-364-2141
Provider Enumeration Date:
10/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  N4352 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 0036097143 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881683159 . This is a "BLUECROSS BLUESHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0N67740 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 208963302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00851107 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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