Kevin Osugi Cisneros

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT95740 Issued in CA

Practice address

1400 Emeline Ave BLDG K
Santa Cruz, CA 95060-1976

Phone

(831) 454-4957

NPI assigned

Jun 25, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Santa Cruz

  • Federally Qualified Health Center (FQHC)
  • Watsonville, CA
  • NPI 1770709149
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1477817476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 HARVEY WEST BLVD",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EMELINE AVE BLDG K",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-454-4957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CISNEROS",
        "first_name": "KEVIN",
        "middle_name": "OSUGI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT95740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANT CRUZ COUNTY MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91892Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martina Halley Chwascinska-Szarek, CNM
• Nicole Cimmarusti
• Inae Cintra Mattiazzi
• Amy Emma Cisneros Rodriguez
• Guadalupe Cisneros
• Stephanie None Cisneros
• Gianluca Ciulla, CMT
• Ellen Clack
• Adriana Del Pilar Clark, DDS
• Derrick J Clark, PHD

• Marriage & Family Therapist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.