Provider Demographics
NPI:1205833381
Name:OMENACA, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:OMENACA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3159
Mailing Address - Country:US
Mailing Address - Phone:305-756-6110
Mailing Address - Fax:305-759-1255
Practice Address - Street 1:9111 PARK DR
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3159
Practice Address - Country:US
Practice Address - Phone:305-756-6110
Practice Address - Fax:305-759-1255
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72943207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
221747OtherAMERIGROUP
GA447OtherVISTA
239859OtherAVMED
25-01608OtherUNITED HEALTH CARE
2862969OtherAETNA HMO
110239492OtherMEDICARE RAILROAD
42952OtherBCBS
001WYOtherPREFERRED CARE
188766OtherHEALTH EASE
9561768008OtherCIGNA
026959OtherNEIGHBORHOOD HEALTH
7868041OtherAETNA NON HMO
1030943OtherCARE PLUS
1807528OtherFIRST HEALTH/COVENTRY
FL253826100Medicaid
25-01608OtherUNITED HEALTH CARE
9561768008OtherCIGNA