Provider Demographics
NPI:1659611523
Name:SUNSHINE CHILD & ADOLESCENT CARE, INC.
Entity Type:Organization
Organization Name:SUNSHINE CHILD & ADOLESCENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TANASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-423-8282
Mailing Address - Street 1:1515 E. FLORENCE BLVD, STE #103
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122
Mailing Address - Country:US
Mailing Address - Phone:520-423-8282
Mailing Address - Fax:520-423-8398
Practice Address - Street 1:1515 E. FLORENCE BLVD, STE #103
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122
Practice Address - Country:US
Practice Address - Phone:520-423-8282
Practice Address - Fax:520-423-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty