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General NPI Number Information
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NPI Number | 1720623283
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Entity Type | Organization
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Legal Business Name | SERENITY COSMETIC SURGERY & REJUVENATION
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 815 SE 1ST AVE STE A
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7102
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Country | US
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Telephone | 305-900-3459
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Fax | 305-900-5372
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Provider Business Mailing Address
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Address Line | 815 SE 1ST AVE STE A
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7102
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Country | US
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Telephone | 305-900-3459
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Fax | 305-900-5372
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Authorized Official
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Title or Position | OWNER
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Name | SAGI SHAKED
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Credential |
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Telephone | 305-900-3459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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