Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 50002 | AZ |
Y | 208D00000X | General Practice Physician | 50002 | AZ |
NPI | 1023249174 |
---|---|
Provider Name | Dr. Jose Gomez Cisneros |
First Address | Phoenix, AZ 85017-5270 |
Second Address | Phoenix, AZ 85017-5270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 03/03/2020 |