Provider Demographics
NPI:1689636391
Name:SOBRADO, JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:SOBRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:SUITE D-17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-270-0402
Mailing Address - Fax:305-595-6179
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE D-17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-270-0402
Practice Address - Fax:305-595-6179
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056369207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038501800Medicaid
FL038501800Medicaid
FL09169Medicare ID - Type Unspecified