Healthcare Provider Details

I. General information

NPI: 1649509613
Provider Name (Legal Business Name): AMILIA OWENS ALMOSARA IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

1083 FOREST SHORE DR
MIRAMAR BEACH FL
32550-3875
US

V. Phone/Fax

Practice location:
  • Phone: 850-884-5649
  • Fax:
Mailing address:
  • Phone: 702-885-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: