Healthcare Provider Details

I. General information

NPI: 1639567613
Provider Name (Legal Business Name): SUNRISE URGENT CARE ASSOCIATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 LITHIA PINECREST RD
VALRICO FL
33596-6301
US

IV. Provider business mailing address

2410 FOUNTAIN GRASS DR
VALRICO FL
33594-6703
US

V. Phone/Fax

Practice location:
  • Phone: 813-643-9393
  • Fax:
Mailing address:
  • Phone: 813-409-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberARNP9226290
License Number StateFL

VIII. Authorized Official

Name: DR. LUIS AGUILA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 813-643-9393