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General NPI Number Information
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NPI Number | 1710916879
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Entity Type | Organization
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Legal Business Name | SUNSHINE MEDICAL INSTITUTE LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5124 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6518
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Country | US
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Telephone | 954-961-9777
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Fax | 954-987-3777
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Provider Business Mailing Address
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Address Line | 5124 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6518
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Country | US
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Telephone | 954-961-9777
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Fax | 954-987-3777
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESENIA BOSCH
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Credential |
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Telephone | 954-961-9777
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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 | HCC5249
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License Number State | FL
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