Provider Demographics
NPI:1063302479
Name:STAR DISTRIBUTION USA CORP
Entity type:Organization
Organization Name:STAR DISTRIBUTION USA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-663-5478
Mailing Address - Street 1:555 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3227
Mailing Address - Country:US
Mailing Address - Phone:561-466-5478
Mailing Address - Fax:
Practice Address - Street 1:555 E 15TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3227
Practice Address - Country:US
Practice Address - Phone:561-466-5478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty