Individual
JOHNNY B SISNEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
106 BLANCA AVE STE 300, ALAMOSA, CO 81101-2340
(719) 589-3658
Mailing address
106 BLANCA AVE STE 300, ALAMOSA, CO 81101-2340
(719) 589-3658
(719) 589-0997
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1122
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840706945058
ROCKY MOUNTAIN HEALTH PLA
CO
01
—
970027495
TRAVELERS MEDICARE
—
Enumeration date
10/24/2005
Last updated
02/19/2020
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