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General NPI Number Information
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NPI Number | 1336249606
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Entity Type | Organization
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Legal Business Name | SUNNY MEDICAL PL, LLC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 11183 S ORANGE BLOSSOM TRL SUITE 204D
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City | ORLANDO
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State | FL
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Zip | 32837-9402
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Country | US
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Telephone | 407-850-0103
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Fax | 407-850-9901
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Provider Business Mailing Address
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Address Line | 11183 S ORANGE BLOSSOM TRL SUITE 204D
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City | ORLANDO
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State | FL
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Zip | 32837-9402
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Country | US
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Telephone | 407-850-0103
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Fax | 407-850-9901
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EMILIA VIVES
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Credential | M.D.
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Telephone | 407-850-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | FL
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