Healthcare Provider Details

I. General information

NPI: 1013858380
Provider Name (Legal Business Name): DOS AGUAS GROUP HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 SW 192ND ST
MIAMI FL
33157-8105
US

IV. Provider business mailing address

11500 SW 192ND ST
MIAMI FL
33157-8105
US

V. Phone/Fax

Practice location:
  • Phone: 786-473-4631
  • Fax: 786-473-4631
Mailing address:
  • Phone: 786-473-4631
  • Fax: 786-473-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: NAIRIM PINO
Title or Position: OWNER
Credential:
Phone: 786-473-4631