Provider Demographics
NPI:1225818156
Name:SARENA, KIMIYO TIFFANY AQUA
Entity Type:Individual
Prefix:
First Name:KIMIYO
Middle Name:TIFFANY AQUA
Last Name:SARENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17757 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1360
Mailing Address - Country:US
Mailing Address - Phone:510-935-8754
Mailing Address - Fax:
Practice Address - Street 1:39159 PASEO PADRE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1623
Practice Address - Country:US
Practice Address - Phone:510-730-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician