Pro Star Pediatrics

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

ME0036554 Issued in FL

Legal business name

PRO STAR PEDIATRICS

Practice address

8701 Maitland Summit Blvd
Orlando, FL 32810-5915

Phone

(407) 916-4522

Fax

(407) 916-4525

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Alberto Cobian

Title

Vice President

Phone

(407) 916-4522

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• RDV Sportsplex Pediatrics Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laritssa Palacio Cobian, MD

  • Pediatric Adolescent Medicine Physician
  • Orlando, FL
  • NPI 1578639894
  NPD (past)
• Marcela Jativa, M.D.

  • Pediatrics Physician
  • Lake Wales, FL
  • NPI 1699942821
  NPD (past)
• Andrea Leigh Vandam, PA

  • Physician Assistant
  • Sebring, FL
  • NPI 1639453640
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392854400000",
    "number": "1972679223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 MAITLAND SUMMIT BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105915",
            "telephone_number": "407-916-4522",
            "fax_number": "407-916-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 MAITLAND SUMMIT BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105915",
            "telephone_number": "407-916-4522",
            "fax_number": "407-916-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO STAR PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2014-02-20",
        "status": "A",
        "authorized_official_last_name": "COBIAN",
        "authorized_official_first_name": "ALBERTO",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "407-916-4522"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "FL",
            "license": "ME0036554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269488300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003657000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041847101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RDV Sportsplex Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Louella Pritchette, D.O.
• Private Healthcare Facilities
• Private Practice Counseling Inc
• Prixus Medical Group LLC
• Pro Health and Care Transportation LLC.
• Proactive Homecare
• Probody Sports Performance
• Ellen Probst, ARNP
• Procare Pharmacy, LLC
• Lauren E Prochnow, CRNA

• Pediatric Adolescent Medicine Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• Pediatric Adolescent Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.