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General NPI Number Information
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NPI Number | 1073122701
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Entity Type | Organization
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Legal Business Name | SUNSHINE WELLNESS CENTER CORP
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1200 NW 78TH AVE STE 215
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City | DORAL
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State | FL
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Zip | 33126-1890
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Country | US
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Telephone | 305-465-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 NW 78TH AVE STE 215
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City | DORAL
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State | FL
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Zip | 33126-1890
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Country | US
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Telephone | 305-465-0908
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAUL OTONIEL GONZALEZ
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Credential |
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Telephone | 305-218-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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