Healthcare Provider Details

I. General information

NPI: 1376863795
Provider Name (Legal Business Name): SERENE SLEEP MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BARRANCA PKWY STE 150
IRVINE CA
92606-8226
US

IV. Provider business mailing address

8 BLUE PT
ALISO VIEJO CA
92656-4265
US

V. Phone/Fax

Practice location:
  • Phone: 949-480-0150
  • Fax: 949-315-3329
Mailing address:
  • Phone: 949-480-0150
  • Fax: 949-315-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number00
License Number StateCA

VIII. Authorized Official

Name: MS. LINA KOVALCHUCK
Title or Position: MANAGER
Credential:
Phone: 949-480-0150