Healthcare Provider Details

I. General information

NPI: 1639353188
Provider Name (Legal Business Name): SUNSHINE WHOLISTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S BROADWAY ST SUITE 103
BOULDER CO
80305-5971
US

IV. Provider business mailing address

805 S BROADWAY ST SUITE 103
BOULDER CO
80305-5971
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-3100
  • Fax:
Mailing address:
  • Phone: 303-449-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35393
License Number StateCO

VIII. Authorized Official

Name: DR. PAUL ANTHONY BERGER
Title or Position: OWNER
Credential: MD
Phone: 303-449-3100