Healthcare Provider Details

I. General information

NPI: 1003663089
Provider Name (Legal Business Name): SERENE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 PASADENA BLVD STE B
PEMBROKE PINES FL
33024-3537
US

IV. Provider business mailing address

2900 W CYPRESS CREEK RD STE 8
FORT LAUDERDALE FL
33309-1715
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-9070
  • Fax:
Mailing address:
  • Phone: 954-437-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MELANIO BRUCETA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 954-437-9070