=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558681528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN D OMS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 CORAL WAY SUITE 208
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-807-9459
-----------------------------------------------------
Fax | 305-264-0253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 650069
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33265-0069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-807-9459
-----------------------------------------------------
Fax | 305-264-0253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JUAN D OMS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-807-9459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME101917
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------