Active NPI
Fidencio Fernandez Cisneros Jr.
- Athletic Trainer
- Riverside, CA
National Provider Identifier
1013606870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 11206 Heathcliff Dr
Riverside, CA 92505-2251 - Phone
- (951) 741-7111
- NPI assigned
- May 5, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | CA | Primary |
Addresses
Primary practice location
11206 Heathcliff Dr
Riverside, CA 92505-2251
Mailing address
11206 Heathcliff Dr
Riverside, CA 92505-2251
Phone (951) 741-7111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683244800000",
"number": "1013606870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11206 HEATHCLIFF DR",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925052251",
"telephone_number": "951-741-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11206 HEATHCLIFF DR",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925052251",
"telephone_number": "951-741-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CISNEROS",
"first_name": "FIDENCIO",
"middle_name": "FERNANDEZ",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-05",
"last_updated": "2023-05-05",
"certification_date": "2023-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.