Healthcare Provider Details

I. General information

NPI: 1558681528
Provider Name (Legal Business Name): JUAN D OMS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CORAL WAY SUITE 208
CORAL GABLES FL
33134-4930
US

IV. Provider business mailing address

PO BOX 650069
MIAMI FL
33265-0069
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-9459
  • Fax: 305-264-0253
Mailing address:
  • Phone: 305-807-9459
  • Fax: 305-264-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME101917
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN D OMS
Title or Position: PRESIDENT
Credential: MD
Phone: 305-807-9459