Provider Demographics
NPI:1659065316
Name:SERENA OF CALIFORNIA
Entity Type:Organization
Organization Name:SERENA OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-415-1446
Mailing Address - Street 1:2405 CONROY AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8964
Mailing Address - Country:US
Mailing Address - Phone:310-415-1446
Mailing Address - Fax:
Practice Address - Street 1:2405 CONROY AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8964
Practice Address - Country:US
Practice Address - Phone:310-415-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty