Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1922656636 |
---|---|
Provider Name | Ms. Monica Jasmine Cisneros I |
First Address | Antioch, CA 94509-4241 |
Second Address | Antioch, CA 94509-4241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6555555555 | (05) | CA |