MEDICARE: INNER STABILITY PSYCHIATRY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1831059484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER STABILITY PSYCHIATRY INC

Provider Business Mailing Address
First Line	:	11850 SW 175TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2259
Country	:	US
Telephone Number	:	305-399-6370
Fax Number	:

Provider Business Practice Location Address
First Line	:	11850 SW 175TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2259
Country	:	US
Telephone Number	:	305-399-6370
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	JORGE ALEJANDRO GAINZA RODRIGUEZ
Credential	:	APRN
Telephone Number	:	305-399-6370

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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