Provider Demographics
NPI:1053321026
Name:MOTA, MARIO C (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:C
Last Name:MOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SOUTH 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-486-3132
Mailing Address - Fax:402-486-3187
Practice Address - Street 1:1101 SOUTH 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-486-3132
Practice Address - Fax:402-486-3187
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE17651207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25784Medicare UPIN
266960Medicare ID - Type Unspecified