Healthcare Provider Details

I. General information

NPI: 1558152298
Provider Name (Legal Business Name): HUGO ANDRES OMS CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NW 109TH AVE APT 213
MIAMI FL
33172-5264
US

IV. Provider business mailing address

290 NW 109TH AVE APT 213
MIAMI FL
33172-5264
US

V. Phone/Fax

Practice location:
  • Phone: 786-776-9213
  • Fax: 786-776-9213
Mailing address:
  • Phone: 786-776-9213
  • Fax: 786-776-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-431058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: