Healthcare Provider Details

I. General information

NPI: 1568576163
Provider Name (Legal Business Name): OPTION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 S MACDILL AVE
TAMPA FL
33611-4450
US

IV. Provider business mailing address

211 4TH AVE N
ST PETERSBURG FL
33701-2911
US

V. Phone/Fax

Practice location:
  • Phone: 727-823-8366
  • Fax: 727-593-2917
Mailing address:
  • Phone: 727-823-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateFL

VIII. Authorized Official

Name: GISELA GARCIA LEYVA
Title or Position: PRESIDENT
Credential: MD
Phone: 813-246-5760