Provider Demographics
NPI:1508360231
Name:ONYX SLEEP DISORDER, INC
Entity Type:Organization
Organization Name:ONYX SLEEP DISORDER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-253-7699
Mailing Address - Street 1:1821 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2419
Mailing Address - Country:US
Mailing Address - Phone:786-953-8338
Mailing Address - Fax:786-364-1602
Practice Address - Street 1:1821 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2419
Practice Address - Country:US
Practice Address - Phone:786-953-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC11305208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1034199OtherHUMANA CARE PLUS