Provider Demographics
NPI:1659071470
Name:SERENITY NUTRITION THERAPY
Entity Type:Organization
Organization Name:SERENITY NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERISTAIN HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:512-766-5920
Mailing Address - Street 1:5900 BALCONES DR STE 10804
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:512-766-5920
Mailing Address - Fax:512-233-0072
Practice Address - Street 1:5900 BALCONES DR STE 10804
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:512-766-5920
Practice Address - Fax:512-233-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty