Provider Demographics
NPI:1417056128
Name:SUNNY ISLES MEDICAL-ASSOCIATES INC
Entity Type:Organization
Organization Name:SUNNY ISLES MEDICAL-ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-933-9929
Mailing Address - Street 1:2760 WEST SUNRISE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33311
Mailing Address - Country:US
Mailing Address - Phone:954-583-9555
Mailing Address - Fax:954-797-8699
Practice Address - Street 1:2760 WEST SUNRISE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-583-9555
Practice Address - Fax:954-797-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2817Medicare ID - Type UnspecifiedMEDICAL CARE
FLU5964AMedicare ID - Type UnspecifiedD.C.
FL62740 XMedicare ID - Type UnspecifiedM.D.