Healthcare Provider Details

I. General information

NPI: 1700610045
Provider Name (Legal Business Name): SUNSHINE INFECTIOUS DISEASE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S ANAHEIM BLVD
ANAHEIM CA
92805-5806
US

IV. Provider business mailing address

30141 ANTELOPE RD # D781
MENIFEE CA
92584-7001
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-6220
  • Fax:
Mailing address:
  • Phone: 951-334-9516
  • Fax: 951-430-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY MORENO
Title or Position: MANAGER
Credential:
Phone: 951-334-9516