MEDICARE: SUNRISE RESEARCH INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1100X	Research Clinic/Center		FL

General Provider Information

NPI Number	:	1538596713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE RESEARCH INSTITUTE INC

Provider Business Mailing Address
First Line	:	434 SW 12TH AVE STE 302
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-2433
Country	:	US
Telephone Number	:	786-409-6849
Fax Number	:	786-409-6872

Provider Business Practice Location Address
First Line	:	434 SW 12TH AVE STE 302
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-2433
Country	:	US
Telephone Number	:	786-409-6849
Fax Number	:	786-409-6872

Authorized Official
Title or Position	:	OWNER
Name	:	YULIEN DIAZ
Credential	:
Telephone Number	:	786-409-6849

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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