Provider Demographics
NPI:1194285163
Name:SERENE THERAPEUTICS LLC
Entity type:Organization
Organization Name:SERENE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-695-0420
Mailing Address - Street 1:82683 CODY DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3157
Mailing Address - Country:US
Mailing Address - Phone:760-984-9441
Mailing Address - Fax:
Practice Address - Street 1:72405 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2716
Practice Address - Country:US
Practice Address - Phone:760-695-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty