MEDICARE: OPTION CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	2084P0800X	Psychiatry Physician	FL
2	101YM0800X	Mental Health Counselor	FL
3	1041C0700X	Clinical Social Worker	FL
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568576163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTION CENTER, INC

Provider Business Mailing Address
First Line	:	211 4TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-2911
Country	:	US
Telephone Number	:	727-823-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	5811 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-4450
Country	:	US
Telephone Number	:	727-823-8366
Fax Number	:	727-593-2917

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GISELA GARCIA LEYVA
Credential	:	MD
Telephone Number	:	813-246-5760

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/21/2013

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Directions to “OPTION CENTER, INC ” Practice Location

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