Provider Demographics
NPI:1730838160
Name:AQUIQUE AGUILAR, OMAR ALI
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ALI
Last Name:AQUIQUE AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11044 DAWNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7421
Mailing Address - Country:US
Mailing Address - Phone:407-283-2285
Mailing Address - Fax:
Practice Address - Street 1:467 LAKE HOWELL RD STE 205&206
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5922
Practice Address - Country:US
Practice Address - Phone:407-449-2812
Practice Address - Fax:407-386-6897
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157701103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst