Provider Demographics
NPI:1710382502
Name:PASTIS, MARITSA COSMIDES (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARITSA
Middle Name:COSMIDES
Last Name:PASTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0430
Mailing Address - Country:US
Mailing Address - Phone:407-782-8232
Mailing Address - Fax:843-559-1663
Practice Address - Street 1:136 E PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2871
Practice Address - Country:US
Practice Address - Phone:386-738-6990
Practice Address - Fax:386-738-6985
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics