Healthcare Provider Details

I. General information

NPI: 1114891397
Provider Name (Legal Business Name): STAR KIDS PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W 49TH ST STE 404-1
HIALEAH FL
33012-2942
US

IV. Provider business mailing address

1840 W 49TH ST STE 404-1
HIALEAH FL
33012-2942
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-9980
  • Fax: 786-507-4734
Mailing address:
  • Phone: 305-828-9980
  • Fax: 786-507-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIAN DIAVANTI
Title or Position: PRESIDENT
Credential: MD
Phone: 786-303-1367