Provider Demographics
NPI:1114588704
Name:SUN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SUN MEDICAL GROUP, INC
Other - Org Name:AFC LADERA RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-214-7764
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92609-0519
Mailing Address - Country:US
Mailing Address - Phone:949-207-3786
Mailing Address - Fax:949-216-3232
Practice Address - Street 1:27522 ANTONIO PKWY STE P3
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2166
Practice Address - Country:US
Practice Address - Phone:714-337-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty