Healthcare Provider Details

I. General information

NPI: 1316866866
Provider Name (Legal Business Name): JONATHAN OMEARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 E LAKES DR
DEERFIELD BEACH FL
33064-8678
US

IV. Provider business mailing address

5009 E LAKES DR
DEERFIELD BEACH FL
33064-8678
US

V. Phone/Fax

Practice location:
  • Phone: 954-940-1027
  • Fax:
Mailing address:
  • Phone: 954-940-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: