Healthcare Provider Details

I. General information

NPI: 1124310651
Provider Name (Legal Business Name): SUNSHINE PAIN MANAGEMENT MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 NE 125TH ST STE 301
NORTH MIAMI FL
33161-5746
US

IV. Provider business mailing address

915 NE 125TH ST STE 301
NORTH MIAMI FL
33161-5746
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-1421
  • Fax: 305-836-1442
Mailing address:
  • Phone: 305-836-1421
  • Fax: 305-836-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOGIN ANTOINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-836-1421