Healthcare Provider Details

I. General information

NPI: 1356836480
Provider Name (Legal Business Name): SERENITY DIAGNOSTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 07/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 MARY JEAN PL
ELK GROVE CA
95758-6111
US

IV. Provider business mailing address

6204 MARY JEAN PL
ELK GROVE CA
95758-6111
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-3067
  • Fax: 916-290-0574
Mailing address:
  • Phone: 916-903-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number201816310597
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number201816310597
License Number StateCA

VIII. Authorized Official

Name: RUSSELL ALLEN STRINGFELLOW
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-903-3067