| Cisco Medical Group, Inc | |
|
18518 Sherman Way Reseda CA 91335-4212 | |
| (818) 757-0954 | |
| (818) 757-0963 |
| Full Name | Cisco Medical Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 18518 Sherman Way, Reseda, California |
| Authorized Official Name and Position | Jose Francisco Martinez Cardenas (PRESIDENT/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8187570954 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cisco Medical Group, Inc 18518 Sherman Way Reseda CA 91335-4212 Ph: (818) 757-0954 | Cisco Medical Group, Inc 18518 Sherman Way Reseda CA 91335-4212 Ph: (818) 757-0954 |
| NPI Number | 1053408989 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 06/11/2024 |
| Medicare PECOS PAC ID | 3173567849 |
|---|---|
| Medicare Enrollment ID | O20050614000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053408989 | NPI | - | NPPES |
| GR0103250 | Medicaid | CA | |
| 05D1055441 | Other | CA | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jose F Martinez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700827052 PECOS PAC ID: 3678517406 Enrollment ID: I20050613001311 |
| Provider Name | Annette Eloise Saldana |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1205883527 PECOS PAC ID: 9032115092 Enrollment ID: I20210803002590 |
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