Provider Demographics
NPI:1003645243
Name:SERENE SERENITY MASSAGE LLC
Entity type:Organization
Organization Name:SERENE SERENITY MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YINGZI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOUSHIASL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-239-2636
Mailing Address - Street 1:1330 AQUARENA SPRINGS DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7241
Mailing Address - Country:US
Mailing Address - Phone:512-667-6666
Mailing Address - Fax:
Practice Address - Street 1:1330 AQUARENA SPRINGS DR STE 109
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7241
Practice Address - Country:US
Practice Address - Phone:512-667-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty