Provider Demographics
NPI:1447276266
Name:CISNEROS, JEANETTE LOPEZ (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:LOPEZ
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1615 BUNKER HILL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-6013
Mailing Address - Country:US
Mailing Address - Phone:831-769-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:559 E ALISAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2516
Practice Address - Country:US
Practice Address - Phone:831-769-8800
Practice Address - Fax:831-422-9312
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15686ZOtherMCARE FACILITY GRP
CAZZZ15683ZOtherMCARE FACILITY GRP
CAFHC70655FMedicaid
CAZZZ15685ZOtherMCARE FACILITY GRP
CAZZZ02040ZOtherMCARE FACILITY GRP
CA00G573452Medicare PIN
CAFHC70655FMedicaid