Provider Demographics
NPI:1710367214
Name:MARIO DUBE, PLLC
Entity Type:Organization
Organization Name:MARIO DUBE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:941-351-4949
Mailing Address - Street 1:9114 TOWN CENTER PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5054
Mailing Address - Country:US
Mailing Address - Phone:941-351-4949
Mailing Address - Fax:941-351-3033
Practice Address - Street 1:9114 TOWN CENTER PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5054
Practice Address - Country:US
Practice Address - Phone:941-351-4949
Practice Address - Fax:941-351-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty