Provider Demographics
NPI:1730742198
Name:SERENITY OAKS, PLLC
Entity type:Organization
Organization Name:SERENITY OAKS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-549-4333
Mailing Address - Street 1:5368 FREDERICKSBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6108
Mailing Address - Country:US
Mailing Address - Phone:210-549-4333
Mailing Address - Fax:210-549-4339
Practice Address - Street 1:5368 FREDERICKSBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6108
Practice Address - Country:US
Practice Address - Phone:210-549-4333
Practice Address - Fax:210-549-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ9906OtherLICENSE