Healthcare Provider Details

I. General information

NPI: 1154467553
Provider Name (Legal Business Name): OMAR QUILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OMAR QUILES-QUINTERO M.D.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CITRUS MEDICAL CT STE 101
OCOEE FL
34761-4548
US

IV. Provider business mailing address

PO BOX 420037
KISSIMMEE FL
34742-0037
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-7246
  • Fax:
Mailing address:
  • Phone: 321-442-8009
  • Fax: 321-442-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME101956
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME101956
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME101956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: