Provider Demographics
NPI:1730844580
Name:SERENITY HOSPICE CARE OF CALIFORNIA INC
Entity type:Organization
Organization Name:SERENITY HOSPICE CARE OF CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CLEMENTE
Authorized Official - Last Name:TATOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-883-6476
Mailing Address - Street 1:1671 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-5420
Mailing Address - Country:US
Mailing Address - Phone:619-883-6476
Mailing Address - Fax:
Practice Address - Street 1:1671 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-5420
Practice Address - Country:US
Practice Address - Phone:619-883-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty