Michael Maxino Soberano, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME78696 Issued in FL

Practice address

493 Prosperity Lake Dr
St Augustine, FL 32092-5045

Phone

(904) 824-5437

Fax

(904) 824-7575

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Augustine Pediatric Associates, PA

  • Pediatrics Physician
  • St Augustine, FL
  • NPI 1447461421
  NPD Authorized official
• St. Augustine Pediatric Associates, PA

  • Pediatrics Physician
  • St Augustine, FL
  • NPI 1629286299
  NPD Authorized official
• Saltzman, Tanis, Pittell, Levin and Jacobson

  • Pediatrics Physician
  • Hollywood, FL
  • NPI 1639138480
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1477596377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 PROSPERITY LAKE DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "904-824-5437",
            "fax_number": "904-824-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 PROSPERITY LAKE DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "904-824-5437",
            "fax_number": "904-824-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBERANO",
        "first_name": "MICHAEL",
        "middle_name": "MAXINO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME78696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257545101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Snider, PHARMD
• Natalia Snigurskaya
• Summer A Snoek, PT
• Jessica Snuggs
• Richard L Snyder, MD
• Edward Andrew Sobolewski, M.D.
• Solantic of Jacksonville, LLC
• Solutions for Employee Advancement LLC
• Somto Medical Supply and Home Health Care
• Songbird Anesthesia Inc

• Pediatrics Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.