MEDICARE: SUNSET SURGICAL SUITES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1215289418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET SURGICAL SUITES CORP

Provider Business Mailing Address
First Line	:	7231 SW 63RD AVE
Second Line	:	2ND FLOOR
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4809
Country	:	US
Telephone Number	:	305-661-1996
Fax Number	:	305-662-2204

Provider Business Practice Location Address
First Line	:	7231 SW 63RD AVE
Second Line	:	2ND FLOOR
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4809
Country	:	US
Telephone Number	:	305-661-1996
Fax Number	:	305-662-2204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE MIGUEL SOLER-BAILLO
Credential	:
Telephone Number	:	305-661-1996

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	10/11/2012

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