Provider Demographics
NPI:1023545787
Name:SERENITY
Entity Type:Organization
Organization Name:SERENITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GABY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFTI
Authorized Official - Phone:702-815-1550
Mailing Address - Street 1:1901 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1260
Mailing Address - Country:US
Mailing Address - Phone:702-815-1550
Mailing Address - Fax:702-815-1554
Practice Address - Street 1:1901 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1260
Practice Address - Country:US
Practice Address - Phone:702-815-1550
Practice Address - Fax:702-815-1554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D2104141291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVWE ARE NOT ENROLLEDMedicaid