MEDICARE: SUNRAY SERVICES LLC

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D2208800	OTHER		CLIA

General Provider Information

NPI Number	:	1720670797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRAY SERVICES LLC

Provider Business Mailing Address
First Line	:	2850 PIO PICO DR STE E
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34249 CAMINO CAPISTRANO STE 185
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1156
Country	:	US
Telephone Number	:	949-359-5669
Fax Number	:	949-315-3252

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MATTHEW LEE
Credential	:
Telephone Number	:	949-359-5669

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/24/2021

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Directions to “SUNRAY SERVICES LLC ” Practice Location

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