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General NPI Number Information
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NPI Number | 1083216022
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Entity Type | Organization
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Legal Business Name | ETERNITY MEDICAL GROUP CORP
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 900 SW 8TH ST STE C1
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City | MIAMI
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State | FL
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Zip | 33130-3756
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Country | US
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Telephone | 786-332-3136
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Fax | 305-726-0013
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Provider Business Mailing Address
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Address Line | 900 SW 8TH ST STE C1
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City | MIAMI
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State | FL
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Zip | 33130-3756
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Country | US
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Telephone | 786-332-3136
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Fax | 305-726-0013
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LUIS AGUILAR
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Credential |
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Telephone | 786-332-3136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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