Provider Demographics
NPI:1720213234
Name:SERENITY SLEEP AND NEURODIAGNOSTICS INC
Entity Type:Organization
Organization Name:SERENITY SLEEP AND NEURODIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEWITTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RCP
Authorized Official - Phone:949-584-1014
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY
Mailing Address - Street 2:#419
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:888-494-8989
Mailing Address - Fax:866-594-4485
Practice Address - Street 1:27758 SANTA MARGARITA PKWY
Practice Address - Street 2:#419
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6709
Practice Address - Country:US
Practice Address - Phone:888-494-8989
Practice Address - Fax:866-594-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic