Provider Demographics
NPI:1447508478
Name:STARFISH PEDIATRICS PA
Entity type:Organization
Organization Name:STARFISH PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-338-5475
Mailing Address - Street 1:PO BOX 17774
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7774
Mailing Address - Country:US
Mailing Address - Phone:904-347-2773
Mailing Address - Fax:904-647-2647
Practice Address - Street 1:4500 HODGES BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2207
Practice Address - Country:US
Practice Address - Phone:904-347-2773
Practice Address - Fax:904-647-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 112541208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty