Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1013829 | TX |
NPI | 1093024168 |
---|---|
Provider Name | Gloria J. Cisneros |
First Address | Laredo, TX 78041-6712 |
Second Address | Laredo, TX 78041-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 06/10/2010 |