MEDICARE: SALUD HEALTHCARE SUNNY ISLES, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1619558772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUD HEALTHCARE SUNNY ISLES, INC.

Provider Business Mailing Address
First Line	:	323 SUNNY ISLES BLVD FL 7
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4232
Country	:	US
Telephone Number	:	954-231-5148
Fax Number	:	954-231-5142

Provider Business Practice Location Address
First Line	:	3363 NE 163RD ST STE 505
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4423
Country	:	US
Telephone Number	:	954-231-5148
Fax Number	:	954-231-5142

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN GRUNER
Credential	:
Telephone Number	:	954-231-5141

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/20/2021

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