Provider Demographics
NPI:1710460811
Name:SUNSHINE SURGICAL AND WOUND CARE LLC
Entity Type:Organization
Organization Name:SUNSHINE SURGICAL AND WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-402-6811
Mailing Address - Street 1:222 N PACIFIC COAST HWY STE 2175
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5639
Mailing Address - Country:US
Mailing Address - Phone:877-850-8762
Mailing Address - Fax:877-480-9940
Practice Address - Street 1:210 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3560
Practice Address - Country:US
Practice Address - Phone:877-850-8762
Practice Address - Fax:877-480-9940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE SURGICAL AND WOUNDCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-13
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty