Provider Demographics
NPI:1083851729
Name:SERENITY SLEEP & NEURODIAGNOSTICS, INC
Entity Type:Organization
Organization Name:SERENITY SLEEP & NEURODIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RCP
Authorized Official - Phone:949-584-1014
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY
Mailing Address - Street 2:#419
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-584-1014
Mailing Address - Fax:866-594-4485
Practice Address - Street 1:4902 IRVINE CENTER DR
Practice Address - Street 2:#101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3305
Practice Address - Country:US
Practice Address - Phone:949-263-4698
Practice Address - Fax:866-594-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15262261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic