Basic Information
| Provider Information | |||||||||
| NPI: | 1023444858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERENITY AND AWARENESS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 690130 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782690130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106018112 | ||||||||
| FaxNumber: | 3307824750 | ||||||||
| Practice Location | |||||||||
| Address1: | 19230 STONEHUE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782583448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106018112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | BAEZ-CURCIO | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2106018112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.