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General NPI Number Information
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NPI Number | 1730838160
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Entity Type | Individual
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Provider Name | OMAR ALI AQUIQUE AGUILAR
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Gender | Male
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 467 LAKE HOWELL RD STE 205&206
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City | MAITLAND
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State | FL
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Zip | 32751-5922
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Country | US
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Telephone | 407-449-2812
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Fax | 407-386-6897
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Provider Business Mailing Address
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Address Line | 11044 DAWNVIEW LN
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City | ORLANDO
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State | FL
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Zip | 32825-7421
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Country | US
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Telephone | 407-283-2285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-21-157701
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License Number State | FL
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