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General NPI Number Information
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NPI Number | 1013341429
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE FAMILY CARE PA
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 16144 CHURCHVIEW DR BUILDING A, SUITE 109
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City | LITHIA
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State | FL
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Zip | 33547-3851
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Country | US
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Telephone | 813-631-9396
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Fax |
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Provider Business Mailing Address
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Address Line | 16144 CHURCHVIEW DR BUILDING A, SUITE 109
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City | LITHIA
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State | FL
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Zip | 33547-3851
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Country | US
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Telephone | 813-631-9396
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONICA RIVERA-AMILL
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Credential | MD
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Telephone | 813-631-9396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME105665
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License Number State | FL
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