Provider Demographics
NPI:1659721900
Name:ONATE, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ONATE
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 1:611 NW 82ND AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6903
Mailing Address - Country:US
Mailing Address - Phone:305-775-6486
Mailing Address - Fax:
Practice Address - Street 1:149 W 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2615
Practice Address - Country:US
Practice Address - Phone:305-775-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist