Organization
HOLLY MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OSMANI R MANSO AGUILAR (OWNER/AUTHORIZED OFFICIAL)
(786) 390-9291
Entity
Organization
Contact information
Practice address
959 SW 122ND AVE, MIAMI, FL 33184-2406
(786) 390-9291
(786) 817-2341
Mailing address
959 SW 122ND AVE, MIAMI, FL 33184-2406
(786) 390-9291
(786) 817-2341
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
05/06/2025
Last updated
01/10/2026
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