Healthcare Provider Details

I. General information

NPI: 1124948799
Provider Name (Legal Business Name): NIRVANA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12175 SW 132ND CT FL 2
MIAMI FL
33186-6410
US

IV. Provider business mailing address

12175 SW 132ND CT FL 2
MIAMI FL
33186-6410
US

V. Phone/Fax

Practice location:
  • Phone: 305-897-0313
  • Fax:
Mailing address:
  • Phone: 305-897-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SANCHEZ PINA
Title or Position: OWNER
Credential:
Phone: 305-897-0313