Provider Demographics
NPI:1821460080
Name:ONTENIENTE, ROMAIN (DPM)
Entity type:Individual
Prefix:DR
First Name:ROMAIN
Middle Name:
Last Name:ONTENIENTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 WOODLEAF HAMMOCK CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-0508
Mailing Address - Country:US
Mailing Address - Phone:954-439-1195
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:6021 142ND AVE N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2822
Practice Address - Country:US
Practice Address - Phone:727-431-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3763213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3763OtherSTATE LICENSE
FL021456100Medicaid