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General NPI Number Information
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NPI Number | 1659540565
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Entity Type | Organization
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Legal Business Name | CELESTE S SOBERANO MD PA
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 8833 PERIMETER PARK BLVD SUITE 401
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1109
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Country | US
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Telephone | 904-996-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 8833 PERIMETER PARK BLVD SUITE 401
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1109
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Country | US
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Telephone | 904-996-8090
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | CELESTE S SOBERANO
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Credential | MD PA
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Telephone | 904-996-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78567
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License Number State | FL
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