Provider Demographics
NPI:1801037536
Name:NIRVANA HOLISTIC HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:NIRVANA HOLISTIC HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:TRINIDAD
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-668-9331
Mailing Address - Street 1:2550 BARWICK ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4208
Mailing Address - Country:US
Mailing Address - Phone:407-668-9331
Mailing Address - Fax:407-517-0339
Practice Address - Street 1:2550 BARWICK ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4208
Practice Address - Country:US
Practice Address - Phone:407-668-9331
Practice Address - Fax:407-517-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty