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General NPI Number Information
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NPI Number | 1609118645
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Entity Type | Organization
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Legal Business Name | SUNSHINE MOBILE MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/16/2013
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Last Update Date | 03/16/2013
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Provider Practice Location Address
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Address Line | 2301 HARVARD AVE
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City | FORT MYERS
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State | FL
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Zip | 33907-4232
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Country | US
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Telephone | 239-206-3328
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 HARVARD AVE
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City | FORT MYERS
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State | FL
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Zip | 33907-4232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NELSON ANTHONY GUZMAN
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Credential | PA-C
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Telephone | 239-206-3328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9105161
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License Number State | FL
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