| Nirvana Clinic Center Llc | |
|
8765 Sw 165th Ave Ste 105 Miami FL 33193-5832 | |
| (786) 577-0024 | |
| (786) 773-2234 |
| Full Name | Nirvana Clinic Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8765 Sw 165th Ave Ste 105, Miami, Florida |
| Authorized Official Name and Position | Daniela Manno (DIRECTOR) |
| Authorized Official Contact | 7865770024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nirvana Clinic Center Llc 8765 Sw 165th Ave Ste 105 Miami FL 33193-5832 Ph: (786) 577-0024 | Nirvana Clinic Center Llc 8765 Sw 165th Ave Ste 105 Miami FL 33193-5832 Ph: (786) 577-0024 |
| NPI Number | 1811357122 |
|---|---|
| Provider Enumeration Date | 02/29/2016 |
| Last Update Date | 11/29/2021 |
| Medicare PECOS PAC ID | 2365854726 |
|---|---|
| Medicare Enrollment ID | O20201209002342 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811357122 | NPI | - | NPPES |
| Provider Name | Vicente A Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598868903 PECOS PAC ID: 0547397887 Enrollment ID: I20100419000729 |
| Provider Name | Benjamin Krasne |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1306189832 PECOS PAC ID: 4880961515 Enrollment ID: I20170530001239 |
| Provider Name | Roxana Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811401490 PECOS PAC ID: 9234393125 Enrollment ID: I20180607000489 |
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