PRO STAR PEDIATRICS NPI 1972679223

NPI Information

NPI: 1972679223
Provider Name: PRO STAR PEDIATRICS

Other Name: RDV SPORTSPLEX PEDIATRICS

Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
ZIP 32810
Phone: (407) 916-4522
Get Directions

PRO STAR PEDIATRICS is an adolescent medicine pediatrics in Orlando, FL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PRO STAR PEDIATRICS NPI is 1972679223. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Rdv Sportsplex Pediatrics.

The provider's business location address is:

8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
ZIP 32810-915
Phone: (407) 916-4522
Fax: (407) 916-4525

The provider's authorized official is Alberto Cobian .
The authorized official title is Vice President and has the following contact phone number (407) 916-4522.

The CLIA number assigned to this NPI record is 10D0950873 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 2/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	ME0036554	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	003657000	MEDICAID	FLORIDA
2	041847101	MEDICAID	FLORIDA
3	269488300	MEDICAID	FLORIDA
4	D55150	MEDICARE UPIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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