Provider Demographics
NPI:1295324853
Name:FERNANDEZ DE SOIGNIE, OMAR (RBT)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:FERNANDEZ DE SOIGNIE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WORTH RD STE 209-7
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3270
Mailing Address - Country:US
Mailing Address - Phone:786-399-8439
Mailing Address - Fax:561-619-7423
Practice Address - Street 1:5700 LAKE WORTH RD STE 209-7
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3270
Practice Address - Country:US
Practice Address - Phone:786-399-8439
Practice Address - Fax:561-619-7423
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106816300Medicaid