ST. AUGUSTINE PEDIATRIC ASSOCIATES, PA
Medical Practice at Plantation Island Dr, Saint Augustine, FL

License number
Florida ME78696
Category
Medical Practice
Type
Pediatrics
Owner
Name: DR. MICHAEL SOBERANO MD
Title: OWNER
Phone: (904) 824-5437
Address
Address
1301 Plantation Island Dr S SUITE 106B, Saint Augustine, FL 32080
National Provider ID: 1629286299
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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St Augustine Pediatric Associates, PA

Saint Augustine, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Registration:
Feb 20, 2003
Phone:
(904) 461-8906 (Phone)
Addresses:
1301 Plantation Is Dr S, Saint Augustine, FL 32080
493 Prosperity Lk Dr, Saint Augustine, FL 32092
1301 Plntn Is Dr S, Saint Augustine, FL 32080
State ID:
P03000020979
Business type:
Domestic for Profit Corporation
Principals:
Michael Soberano President, Owner, inactive,Homero Sicangco Medical Doctor, Pediatrics, inactive,Sean Sheppard Principal, inactive
Categories:
Physicians & Surgeons

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