Healthcare Provider Details

I. General information

NPI: 1134996218
Provider Name (Legal Business Name): SERENITY MED GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SW 107TH AVE STE 203
MIAMI FL
33176-1451
US

IV. Provider business mailing address

8900 SW 107TH AVE STE 203
MIAMI FL
33176-1451
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-4823
  • Fax: 786-558-4839
Mailing address:
  • Phone: 786-558-4823
  • Fax: 786-558-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAVIER NARANJO
Title or Position: PRESIDENT
Credential:
Phone: 786-558-4823