Healthcare Provider Details

I. General information

NPI: 1649108515
Provider Name (Legal Business Name): ETERNITY MEDICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SW 8TH ST STE C1
MIAMI FL
33130-3756
US

IV. Provider business mailing address

900 SW 8TH ST STE C1
MIAMI FL
33130-3756
US

V. Phone/Fax

Practice location:
  • Phone: 786-332-3136
  • Fax: 305-726-0013
Mailing address:
  • Phone: 786-332-3136
  • Fax: 305-726-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS AGUILAR
Title or Position: OWNER/CEO
Credential:
Phone: 786-332-3136