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Organization

ST. AUGUSTINE PEDIATRIC ASSOCIATES, PA

Active
Parent organization
ST. AUGUSTINE PEDIATRICS
Organization subpart
Yes

Provider details

NPI number
Legal business name
ST. AUGUSTINE PEDIATRICS
Authorized official
MICHAEL SOBERANO M.D. (OWNER)
(904) 824-5437
Entity
Organization

Contact information

Practice address
493 PROSPERITY LAKE DR, ST AUGUSTINE, FL 32092-5045
(904) 824-5437
(904) 824-7575
Mailing address
493 PROSPERITY LAKE DR, ST AUGUSTINE, FL 32092-5045
(904) 824-5437
(904) 824-7575

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME78696
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
257545101
FL
Enumeration date
05/24/2007
Last updated
07/21/2015
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