Provider Demographics
NPI:1578639894
Name:COBIAN, LARITSSA PALACIO (MD)
Entity Type:Individual
Prefix:
First Name:LARITSSA
Middle Name:PALACIO
Last Name:COBIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARITSSA
Other - Middle Name:
Other - Last Name:PALACIO-LATORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8701 MAITLAND SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5915
Mailing Address - Country:US
Mailing Address - Phone:407-916-4522
Mailing Address - Fax:407-916-4525
Practice Address - Street 1:8701 MAITLAND SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5915
Practice Address - Country:US
Practice Address - Phone:407-916-4522
Practice Address - Fax:407-916-4525
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME852082080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57651OtherBCBS FILING NUMBER