Healthcare Provider Details

I. General information

NPI: 1427610815
Provider Name (Legal Business Name): SUNSHINE ANESTHESIA & WELLNESS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4997 SW 162ND AVE
MIRAMAR FL
33027-4956
US

IV. Provider business mailing address

4997 SW 162ND AVE
MIRAMAR FL
33027-4956
US

V. Phone/Fax

Practice location:
  • Phone: 305-386-3967
  • Fax: 305-386-3969
Mailing address:
  • Phone: 305-386-3967
  • Fax: 305-386-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MOGIN ANTOINE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-836-1421