Provider Demographics
NPI:1639567613
Name:SUNRISE URGENT CARE ASSOCIATE LLC
Entity Type:Organization
Organization Name:SUNRISE URGENT CARE ASSOCIATE LLC
Other - Org Name:LATE HOUR URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-643-9393
Mailing Address - Street 1:2410 FOUNTAIN GRASS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6703
Mailing Address - Country:US
Mailing Address - Phone:813-409-3961
Mailing Address - Fax:
Practice Address - Street 1:3444 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6301
Practice Address - Country:US
Practice Address - Phone:813-643-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226290261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care