MEDICARE: CARLOS OMENACA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME72943	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110239492	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	221747	OTHER	AMERIGROUP
2	GA447	OTHER	VISTA
3	239859	OTHER	AVMED
4	25-01608	OTHER	UNITED HEALTH CARE
5	2862969	OTHER	AETNA HMO
7	42952	OTHER	BCBS
8	001WY	OTHER	PREFERRED CARE
9	188766	OTHER	HEALTH EASE
10	9561768008	OTHER	CIGNA
11	026959	OTHER	NEIGHBORHOOD HEALTH
12	7868041	OTHER	AETNA NON HMO
13	1030943	OTHER	CARE PLUS
14	1807528	OTHER	FIRST HEALTH/COVENTRY
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205833381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS OMENACA MD

Provider Business Mailing Address
First Line	:	9111 PARK DR
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-3159
Country	:	US
Telephone Number	:	305-756-6110
Fax Number	:	305-759-1255

Provider Business Practice Location Address
First Line	:	9111 PARK DR
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-3159
Country	:	US
Telephone Number	:	305-756-6110
Fax Number	:	305-759-1255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/28/2022

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Directions to “ CARLOS OMENACA MD” Practice Location

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