Healthcare Provider Details

I. General information

NPI: 1881246395
Provider Name (Legal Business Name): SERENITY WELLNESS INSTITUTE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NW 22ND AVE
MIAMI FL
33125-2738
US

IV. Provider business mailing address

1111 NW 22ND AVE
MIAMI FL
33125-2738
US

V. Phone/Fax

Practice location:
  • Phone: 786-440-0904
  • Fax:
Mailing address:
  • Phone: 786-440-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DIMAS ASENCIO
Title or Position: OWNER
Credential:
Phone: 754-217-0411