=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780728642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNYSIDE FAMILY HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3645 WILLIAMS BLVD #104
-----------------------------------------------------
City | KENNER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70065-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-464-8883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3645 WILLIAMS BLVD #104
-----------------------------------------------------
City | KENNER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70065-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-464-8883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSE L VERAS POLA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-464-8883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 201033
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 15344R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------