Provider Demographics
NPI:1891936464
Name:TOBON, SEBASTIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:TOBON
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 1:1611 NW 12TH AVE
Mailing Address - Street 2:REHAB CENTER-BASEMENT FLOOR, ROOM L 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-1320
Mailing Address - Fax:305-585-1340
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:REHAB CENTER-BASEMENT FLOOR, ROOM L 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1320
Practice Address - Fax:305-585-1340
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113328208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME113328OtherFLORIDA STATE MEDICAL BOARD