Provider Demographics
NPI:1568576163
Name:OPTION CENTER, INC
Entity Type:Organization
Organization Name:OPTION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GISELA
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-246-5760
Mailing Address - Street 1:211 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2911
Mailing Address - Country:US
Mailing Address - Phone:727-823-8366
Mailing Address - Fax:
Practice Address - Street 1:5811 S MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-4450
Practice Address - Country:US
Practice Address - Phone:727-823-8366
Practice Address - Fax:727-593-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X, 1041C0700X, 2084P0800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274116400Medicaid
FL104714Medicare Oscar/Certification
FLK6409Medicare PIN