Provider Demographics
NPI:1437362761
Name:ONATE, BORIS FABRICIO (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:FABRICIO
Last Name:ONATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BACK STAGE LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE BUENA VISTA
Mailing Address - State:FL
Mailing Address - Zip Code:32830
Mailing Address - Country:US
Mailing Address - Phone:407-934-4100
Mailing Address - Fax:407-934-4101
Practice Address - Street 1:960 BACK STAGE LANE
Practice Address - Street 2:
Practice Address - City:LAKE BUENA VISTA
Practice Address - State:FL
Practice Address - Zip Code:32830
Practice Address - Country:US
Practice Address - Phone:407-934-4100
Practice Address - Fax:407-934-4101
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278390800Medicaid
FLAE413XMedicare PIN
FLAE413YMedicare PIN
FLAE413ZMedicare PIN