Healthcare Provider Details

I. General information

NPI: 1013014083
Provider Name (Legal Business Name): SUNLITE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 W 4TH AVE
HIALEAH FL
33012-3939
US

IV. Provider business mailing address

4811 W 4TH AVE
HIALEAH FL
33012-3939
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-0068
  • Fax: 305-819-4445
Mailing address:
  • Phone: 305-822-0068
  • Fax: 305-819-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME97042
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME97042
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME97042
License Number StateFL

VIII. Authorized Official

Name: PABLO M GUALA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-822-0068