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NPI Code Detail

MEDICARE: SUNLAND MEDICAL GROUP,INC

MEDICARE: SUNLAND MEDICAL GROUP,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
1207Q00000XFamily Medicine PhysicianA36020CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2W18496OTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588758411
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNLAND MEDICAL GROUP,INC
Provider Business Mailing Address
First Line : 7709 FOOTHILL BLVD
Second Line :
City : TUJUNGA
State : CA
Zip : 91042-2120
Country : US
Telephone Number : 818-352-3146
Fax Number : 818-352-8116
Provider Business Practice Location Address
First Line : 7709 FOOTHILL BLVD
Second Line :
City : TUJUNGA
State : CA
Zip : 91042-2120
Country : US
Telephone Number : 818-352-3146
Fax Number : 818-352-8116
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. EMILIE G MORADA
Credential :
Telephone Number : 818-352-3146
Provider Enumeration Date : 10/03/2006
Last Update Date : 10/10/2007

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Directions to “SUNLAND MEDICAL GROUP,INC ” Practice Location

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