Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME0062520 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME0062520 | FL |
NPI | 1154497345 |
---|---|
Provider Name | Dr. Mario R Sobrino |
First Address | Orlando, FL 32861-6788 |
Second Address | Kissimmee, FL 34741-4421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B52895235 | DEA (01) | |
F40243 | (02) | |
ME0062520 | FLORIDA LICENSE (01) |