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General NPI Number Information
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NPI Number | 1144400540
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Entity Type | Organization
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Legal Business Name | SUN 'N LAKE MEDICAL GROUP,PA
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 511 W INTERLAKE BLVD
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City | LAKE PLACID
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State | FL
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Zip | 33852-0703
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Country | US
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Telephone | 863-699-1220
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Fax | 863-699-1811
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Provider Business Mailing Address
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Address Line | 511 W INTERLAKE BLVD
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City | LAKE PLACID
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State | FL
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Zip | 33852-0703
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Country | US
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Telephone | 863-699-1220
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Fax | 863-699-1811
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAISA CAMILO
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Credential |
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Telephone | 863-385-2659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | ME61030
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License Number State | FL
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