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General NPI Number Information
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NPI Number | 1568593937
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Entity Type | Organization
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Legal Business Name | SUNRISE PRIMARY CARE INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 219 N PALM AVE
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City | PALATKA
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State | FL
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Zip | 32177-2627
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Country | US
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Telephone | 386-325-8002
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Fax | 386-325-8055
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | PALATKA
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State | FL
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Zip | 32178-0249
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Country | US
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Telephone | 386-325-8002
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Fax | 386-325-8055
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Authorized Official
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Title or Position | PRES
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Name | DR. MARIA-JOSEFINA S RIVERA
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Credential | M.D.
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Telephone | 386-325-8002
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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 | ME 76342
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License Number State | FL
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