Provider Demographics
NPI:1417366253
Name:STATUS MED ASSISTANCE, LLC
Entity Type:Organization
Organization Name:STATUS MED ASSISTANCE, LLC
Other - Org Name:SUNNY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBUCEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-306-0000
Mailing Address - Street 1:17070 COLLINS AVE
Mailing Address - Street 2:257
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3635
Mailing Address - Country:US
Mailing Address - Phone:305-306-0000
Mailing Address - Fax:305-306-1111
Practice Address - Street 1:17070 COLLINS AVE
Practice Address - Street 2:257
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3635
Practice Address - Country:US
Practice Address - Phone:305-306-0000
Practice Address - Fax:305-306-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006257100Medicaid
FLGJ2842OtherMEDICARE