Provider Demographics
NPI:1073016622
Name:STARLIGHT PEDIATRICS URGENT CARE, PLLC
Entity Type:Organization
Organization Name:STARLIGHT PEDIATRICS URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ATOLAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-791-5827
Mailing Address - Street 1:1215 N IVY LOOP
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 N IVY LOOP
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5406
Practice Address - Country:US
Practice Address - Phone:347-791-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care