Healthcare Provider Details

I. General information

NPI: 1033958111
Provider Name (Legal Business Name): MIRIAN F SERAFIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CENTER AVE
VISALIA CA
93291-5913
US

IV. Provider business mailing address

4034 S DEMAREE ST
VISALIA CA
93277-9476
US

V. Phone/Fax

Practice location:
  • Phone: 559-738-0700
  • Fax: 559-738-0710
Mailing address:
  • Phone: 559-738-0700
  • Fax: 559-738-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: