Provider Demographics
NPI:1114891397
Name:STAR KIDS PEDIATRICS CORP
Entity type:Organization
Organization Name:STAR KIDS PEDIATRICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAVANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-303-1367
Mailing Address - Street 1:1840 W 49TH ST STE 404-1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-828-9980
Mailing Address - Fax:786-507-4734
Practice Address - Street 1:1840 W 49TH ST STE 404-1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-828-9980
Practice Address - Fax:786-507-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center