Healthcare Provider Details

I. General information

NPI: 1124753496
Provider Name (Legal Business Name): IRENE SERRATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E DEVONSHIRE AVE STE 201
HEMET CA
92543-3033
US

IV. Provider business mailing address

1011 E DEVONSHIRE AVE STE 201
HEMET CA
92543-3033
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone: 909-599-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT145805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: