Provider Demographics
NPI:1063658177
Name:OMEGA MEDICAL CENTER
Entity Type:Organization
Organization Name:OMEGA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-364-1104
Mailing Address - Street 1:4355 W 16TH AVE
Mailing Address - Street 2:SUITE# 212
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7666
Mailing Address - Country:US
Mailing Address - Phone:305-364-1104
Mailing Address - Fax:305-364-1103
Practice Address - Street 1:4355 W 16TH AVE
Practice Address - Street 2:SUITE# 212
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7666
Practice Address - Country:US
Practice Address - Phone:305-364-1104
Practice Address - Fax:305-364-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4051111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty