Healthcare Provider Details

I. General information

NPI: 1659859791
Provider Name (Legal Business Name): DANIEL SUMILLER URRUCHI SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 NE 163RD ST APT 608
SUNNY ISLES BEACH FL
33160-4445
US

IV. Provider business mailing address

2903 NE 163RD ST APT 608
SUNNY ISLES BEACH FL
33160-4445
US

V. Phone/Fax

Practice location:
  • Phone: 305-340-1145
  • Fax:
Mailing address:
  • Phone: 305-340-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2720-P.A.
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2720-P.A.
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: