Provider Demographics
NPI:1588044184
Name:DORI LYN LALANNE
Entity Type:Organization
Organization Name:DORI LYN LALANNE
Other - Org Name:SERENITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:LALANNE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:760-699-8685
Mailing Address - Street 1:69930 HIGHWAY 111
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2850
Mailing Address - Country:US
Mailing Address - Phone:760-699-8685
Mailing Address - Fax:
Practice Address - Street 1:69930 HIGHWAY 111
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2850
Practice Address - Country:US
Practice Address - Phone:760-699-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36397335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier