Provider Demographics
NPI:1376308551
Name:SERVATI, SENNA (LAC)
Entity Type:Individual
Prefix:
First Name:SENNA
Middle Name:
Last Name:SERVATI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2754
Mailing Address - Country:US
Mailing Address - Phone:619-307-9706
Mailing Address - Fax:
Practice Address - Street 1:1165 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2754
Practice Address - Country:US
Practice Address - Phone:619-307-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist