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Organization

SERENDESTINY ENTERPRISE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LYDIA DIZON JAZMINES MD (PRESIDENT)
(630) 922-3922
Entity
Organization

Contact information

Practice address
3555 VANILLA GRASS DR, NAPERVILLE, IL 60564-8331
(630) 922-3922
(630) 922-3923
Mailing address
355 VANILLA GRASS DRIVE, NAPERVILLE, IL 60564-8331
(630) 922-3922
(630) 922-3923

Taxonomy

Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
036055400
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036055400
IL
Enumeration date
07/10/2008
Last updated
07/10/2008
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