Individual
MATTHEW SOBERANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
690 DALLAS HWY STE 101, VILLA RICA, GA 30180-1262
(770) 459-0620
Mailing address
10013 VINEYARD LAKE RD E, JACKSONVILLE, FL 32256-1485
(904) 923-3135
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
91572
GA
207R00000X
Internal Medicine Physician
91572
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/12/2017
Last updated
11/02/2023
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