Holly Medical Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

HOLLY MEDICAL CLINIC LLC

Practice address

959 SW 122ND Ave
Miami, FL 33184-2406

Phone

(786) 390-9291

Fax

(786) 817-2341

NPI assigned

May 6, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Osmani R Manso Aguilar

Title

Owner/Authorized Official

Phone

(786) 390-9291

Specialties & licenses 15

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elvis Radhames Caraballo Antonio, MD

  • Internal Medicine Physician
  • Wellington, FL
  • NPI 1609516426
  Medicare reassignment NPD
• Luis Anibal Queral, MD

  • Vascular Surgery Physician
  • Hialeah, FL
  • NPI 1780652727
  Medicare reassignment NPD
• Ivelice D Lozano Oliver, OWNER

  • Mental Health Counselor
  • Miami, FL
  • NPI 1174312540
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768003200000",
    "number": "1992594766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "959 SW 122ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331842406",
            "telephone_number": "786-390-9291",
            "fax_number": "786-817-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 SW 122ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331842406",
            "telephone_number": "786-390-9291",
            "fax_number": "786-817-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-06",
        "last_updated": "2026-01-10",
        "certification_date": "2026-01-10",
        "status": "A",
        "authorized_official_last_name": "MANSO AGUILAR",
        "authorized_official_first_name": "OSMANI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "786-390-9291"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Hollingsworth, ARNP
• Grace Hollis
• Hollistic Medical Center Inc
• Aaron Holloway
• Holly Bedotto, PSYD, LLC
• Marie Tarhena Holly, M.D.
• Ralph Holly
• Dominique Patrina Holman
• Kaila Holmes Copeland
• Dorothy A Holmes, PHD

• Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.