Provider Demographics
NPI:1154497345
Name:SOBRINO, MARIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
Last Name:SOBRINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-533-6835
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:327 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4421
Practice Address - Country:US
Practice Address - Phone:407-483-2000
Practice Address - Fax:407-483-2003
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062520207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0062520OtherFLORIDA LICENSE
ME0062520OtherFLORIDA LICENSE
ME0062520OtherFLORIDA LICENSE
F40243Medicare UPIN