=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952104317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O M CENTER SERVICES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2025
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8132 OKEECHOBEE BLVD STE A
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-457-3452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8132 OKEECHOBEE BLVD STE A
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-457-3452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUAN ANTONIO DORADO
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 786-457-3452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------