Healthcare Provider Details

I. General information

NPI: 1205152022
Provider Name (Legal Business Name): SUNSHINE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DR SUITE C4
PEORIA AZ
85381-4841
US

IV. Provider business mailing address

13660 N 94TH DR SUITE C4
PEORIA AZ
85381-4841
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-1722
  • Fax: 623-266-1746
Mailing address:
  • Phone: 623-266-1722
  • Fax: 623-266-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number081064
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15815
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15343
License Number StateAZ

VIII. Authorized Official

Name: MS. TIFFANY NICOLE MITCHELL
Title or Position: NATUROPATHIC MEDICAL DOCTOR/MEDICAL
Credential: N.M.D.
Phone: 480-298-4759