Individual
DR. MICHAEL MAXINO SOBERANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
06/14/2006
Last updated
07/09/2020
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