Provider Demographics
NPI:1497997761
Name:SOBERON-CASSAR, ANGELICA MARIA (MD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:SOBERON-CASSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:SOBERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:126 VERDAE CREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3961
Mailing Address - Country:US
Mailing Address - Phone:864-546-0153
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5622
Practice Address - Country:US
Practice Address - Phone:864-797-7100
Practice Address - Fax:864-797-7105
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT157658208100000X
SC35710208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCAPPROVEDOtherRAILROAD MEDICARE
SCAPPROVEDOtherRAILROAD MEDICARE