Provider Demographics
NPI:1215475579
Name:OMIER, OLIMPIA
Entity type:Individual
Prefix:MISS
First Name:OLIMPIA
Middle Name:
Last Name:OMIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20345 W COUNTRY CLUB DR
Mailing Address - Street 2:TOWN HOUSE - 14
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1631
Mailing Address - Country:US
Mailing Address - Phone:305-792-2493
Mailing Address - Fax:
Practice Address - Street 1:20345 W COUNTRY CLUB DR
Practice Address - Street 2:TOWN HOUSE - 14
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1631
Practice Address - Country:US
Practice Address - Phone:305-792-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLATN: 654338Medicaid