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NPI Code Detail

MEDICARE: SUNSHINE SURGICAL AND WOUND CARE LLC

MEDICARE: SUNSHINE SURGICAL AND WOUND CARE 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
1208600000XSurgery Physician

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 : 1952843716
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNSHINE SURGICAL AND WOUND CARE LLC
Provider Business Mailing Address
First Line : 222 N PACIFIC COAST HWY STE 2175
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5639
Country : US
Telephone Number : 877-850-8762
Fax Number : 877-486-9940
Provider Business Practice Location Address
First Line : 1735 N TREASURE DR
Second Line :
City : NORTH BAY VILLAGE
State : FL
Zip : 33141-4216
Country : US
Telephone Number : 877-850-8762
Fax Number : 877-486-9940
Authorized Official
Title or Position : CEO
Name : ROBERT J MARRIOTT
Credential : MD
Telephone Number : 877-850-8762
Provider Enumeration Date : 11/10/2016
Last Update Date : 11/08/2018

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Directions to “SUNSHINE SURGICAL AND WOUND CARE LLC ” Practice Location

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