Organization
PRO STAR PEDIATRICS
Active
Other names
RDV Sportsplex Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERTO COBIAN (VICE PRESIDENT)
(407) 916-4522
Entity
Organization
Contact information
Practice address
8701 MAITLAND SUMMIT BLVD, ORLANDO, FL 32810-5915
(407) 916-4522
(407) 916-4525
Mailing address
8701 MAITLAND SUMMIT BLVD, ORLANDO, FL 32810-5915
(407) 916-4522
(407) 916-4525
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME0036554
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003657000
—
FL
05
—
041847101
—
FL
05
—
269488300
—
FL
Enumeration date
11/28/2006
Last updated
02/20/2014
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