Provider Demographics
NPI:1013014083
Name:SUNLITE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SUNLITE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-0068
Mailing Address - Street 1:4811 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3939
Mailing Address - Country:US
Mailing Address - Phone:305-822-0068
Mailing Address - Fax:305-819-4445
Practice Address - Street 1:4811 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3939
Practice Address - Country:US
Practice Address - Phone:305-822-0068
Practice Address - Fax:305-819-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97042207RC0000X, 207RI0011X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276796100Medicaid
FL=========OtherEIN NUMBER