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General NPI Number Information
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NPI Number | 1427610815
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Entity Type | Organization
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Legal Business Name | SUNSHINE ANESTHESIA & WELLNESS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 4997 SW 162ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-4956
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Country | US
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Telephone | 305-386-3967
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Fax | 305-386-3969
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Provider Business Mailing Address
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Address Line | 4997 SW 162ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-4956
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Country | US
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Telephone | 305-386-3967
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Fax | 305-386-3969
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. MOGIN ANTOINE
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Credential | MD
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Telephone | 305-836-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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