=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750433678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE URGENT CARE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 03/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13162 US HIGHWAY 301 S
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33578-7410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-677-8788
-----------------------------------------------------
Fax | 813-677-8806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13162 US HIGHWAY 301 S
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33578-7410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-677-8788
-----------------------------------------------------
Fax | 136-778-8068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. LUIS A AGUILA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-677-8788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------