Healthcare Provider Details

I. General information

NPI: 1912957697
Provider Name (Legal Business Name): SUNRISE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 SHERIDAN ST 200
HOLLYWOOD FL
33021-2829
US

IV. Provider business mailing address

6245 N FEDERAL HWY SUITE 300
FORT LAUDERDALE FL
33308-1998
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-3850
  • Fax: 954-981-3889
Mailing address:
  • Phone: 954-956-1966
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNE ZYGALA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 954-956-1966