Provider Demographics
NPI:1609673029
Name:CISNEROS, ADRIANA LIZETTE
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LIZETTE
Last Name:CISNEROS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 MAIN ST APT 31
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-3529
Mailing Address - Country:US
Mailing Address - Phone:669-288-4583
Mailing Address - Fax:
Practice Address - Street 1:20555 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5212
Practice Address - Country:US
Practice Address - Phone:650-930-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-25-79467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst