Provider Demographics
NPI:1831584168
Name:NIMITYONGSKUL, SERENA LA (BS)
Entity type:Individual
Prefix:MS
First Name:SERENA
Middle Name:LA
Last Name:NIMITYONGSKUL
Suffix:
Gender:F
Credentials:BS
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Mailing Address - Street 1:5750A SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 BISHOP LN N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5821
Practice Address - Country:US
Practice Address - Phone:251-450-4359
Practice Address - Fax:251-450-4323
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2020-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.362942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry