Eternity Medical Group Corp

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ETERNITY MEDICAL GROUP CORP

Practice address

900 SW 8TH St Ste C1
Miami, FL 33130-3756

Phone

(786) 332-3136

Fax

(305) 726-0013

NPI assigned

Nov 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luis Aguilar

Title

Owner/President

Phone

(786) 332-3136

Specialties & licenses 7

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Eternity Medical Group Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Eternity Medical Group Corp

  • Non-emergency Medical Transport (VAN)
  • Miami, FL
  • NPI 1457199267
  NPD tax ID
• Eternity Medical Group Corp

  • Multi-Specialty Clinic/Center
  • Miami, FL
  • NPI 1649108515
  NPD tax ID

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Alvarenga

  • Clinical Social Worker
  • Miami, FL
  • NPI 1396562591
  Medicare reassignment NPD
• Maria Antonia Monzon, NP

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1558810762
  Medicare reassignment NPD
• Karen Romero, LMHC

  • Mental Health Counselor
  • Miami, FL
  • NPI 1275185613
  Medicare reassignment NPD
• Raisa Shum Alfonso, ARNP

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1871070425
  Medicare reassignment NPD
• Luis M Campillo, MD

  • Family Medicine Physician
  • Miami, FL
  • NPI 1922054352
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1083216022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SW 8TH ST STE C1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303756",
            "telephone_number": "786-332-3136",
            "fax_number": "305-726-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SW 8TH ST STE C1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303756",
            "telephone_number": "786-332-3136",
            "fax_number": "305-726-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNITY MEDICAL GROUP CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "AGUILAR",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "786-332-3136"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE CLINIC STANDARD LICENSE",
            "identifier": "13052",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108835400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eternal Life Services Corp
• Eternity Community Mental Health Corp
• Eternity Estates Corp.
• Eternity Life Care LLC
• Eternity Lives
• Eternity Medical Group Corp
• Eternity Medical Group Corp
• Ethereal Medspa LLC
• Ethereal Medspa LLC
• Ethos Behavioral Therapy LLC

• Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.