Provider Demographics
NPI:1942384391
Name:SOBRINO, MARCO A (MD, FACS)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:SOBRINO
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 116TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3817
Mailing Address - Country:US
Mailing Address - Phone:425-296-0010
Mailing Address - Fax:425-454-1124
Practice Address - Street 1:16122 8TH AVE SW
Practice Address - Street 2:SUITE D1
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2967
Practice Address - Country:US
Practice Address - Phone:206-244-1680
Practice Address - Fax:206-243-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ40371208600000X
WAMD00039788208600000X
OK25459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8372831Medicaid
WAH85630Medicare UPIN
OK24M733105Medicare PIN
WA8372831Medicaid
OKP00454823Medicare PIN