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General NPI Number Information
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NPI Number | 1952601411
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Entity Type | Organization
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Legal Business Name | SUNRISE DIAGNOSTICS GROUP, LLC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 3185 BOUTWELL RD
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City | LAKE WORTH
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State | FL
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Zip | 33461-2610
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Country | US
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Telephone | 561-748-2889
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7240
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City | JUPITER
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State | FL
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Zip | 33468-7240
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Country | US
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Telephone | 561-748-2889
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Fax |
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Authorized Official
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Title or Position | JUPITER PROFESSIONAL DEVELOPMENT
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Name | KAREN BARLOW
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Credential | PRESIDENT
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Telephone | 561-748-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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