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General NPI Number Information
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NPI Number | 1770934119
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Entity Type | Organization
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Legal Business Name | SERENITY PLUS HEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 441 NW 188TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3297
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Country | US
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Telephone | 305-319-1521
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Fax | 954-399-8507
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Provider Business Mailing Address
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Address Line | 441 NW 188TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3297
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Country | US
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Telephone | 305-319-1521
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Fax | 954-399-8507
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSENIE DESAMOUR
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Credential | MD
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Telephone | 305-319-1521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME115161
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License Number State | FL
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