=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265300172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUX ET FIDES FAMILY THERAPY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17200 NEWHOPE ST
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-4229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-285-7648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9871
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92728-9871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-285-7648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | MR. DIEGO SERRATO
-----------------------------------------------------
Credential | LMFT, APCC
-----------------------------------------------------
Telephone | 562-285-7648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------