MEDICARE: SUNRISE MEDCARE CENTER 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	363L00000X	Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1730844549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MEDCARE CENTER INC

Provider Business Mailing Address
First Line	:	80 WILSON BLVD S STE 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34117-9386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 WILSON BLVD S STE 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34117-9386
Country	:	US
Telephone Number	:	239-208-5990
Fax Number	:	239-302-6813

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ALFREDO GONZALEZ-VERGARA
Credential	:	MD
Telephone Number	:	305-409-9681

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	11/05/2021

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