Healthcare Provider Details

I. General information

NPI: 1154497345
Provider Name (Legal Business Name): MARIO R SOBRINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/07/2023
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W OAK ST
KISSIMMEE FL
34741-4421
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-2000
  • Fax: 407-483-2003
Mailing address:
  • Phone: 407-533-6835
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0062520
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0062520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: