Individual
OMAR SUID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12001 DR M.L.K. JR STREET NORTH, 3803, SAINT PETERSBURG, FL 33716-1611
(727) 318-0498
Mailing address
12001 DR M.L.K. JR STREET NORTH, 3803, SAINT PETERSBURG, FL 33716-1611
(727) 318-0498
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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