Provider Demographics
NPI:1285179754
Name:BERNADETTE ROUMBOS LLC
Entity Type:Organization
Organization Name:BERNADETTE ROUMBOS LLC
Other - Org Name:SERENE NUTRITION-WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:590-644-1142
Mailing Address - Street 1:120 S HOUGHTON RD
Mailing Address - Street 2:SUITE 138-314
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6731
Mailing Address - Country:US
Mailing Address - Phone:602-644-1142
Mailing Address - Fax:
Practice Address - Street 1:2060 W WHISPERING WIND DR
Practice Address - Street 2:#274
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2867
Practice Address - Country:US
Practice Address - Phone:602-644-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ874789 RDN261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service