Individual
DERRICK CISNEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14600 SHERMAN WAY STE 100D, VAN NUYS, CA 91405-5869
(818) 374-6901
Mailing address
14600 SHERMAN WAY STE 100D, VAN NUYS, CA 91405-5869
(818) 374-6901
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Enumeration date
11/22/2021
Last updated
11/22/2021
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