Provider Demographics
NPI:1235464751
Name:OMSA DELRAY BEACH PA
Entity Type:Organization
Organization Name:OMSA DELRAY BEACH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ-GARCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-278-0004
Mailing Address - Street 1:505 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5263
Mailing Address - Country:US
Mailing Address - Phone:561-278-0004
Mailing Address - Fax:561-278-0005
Practice Address - Street 1:505 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5263
Practice Address - Country:US
Practice Address - Phone:561-278-0004
Practice Address - Fax:561-278-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18421261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery