Provider Demographics
NPI:1861837882
Name:SUNLIGHT MEDICAL GROUP
Entity Type:Organization
Organization Name:SUNLIGHT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-800-8376
Mailing Address - Street 1:7225 NW 25TH ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1706
Mailing Address - Country:US
Mailing Address - Phone:786-800-8376
Mailing Address - Fax:305-477-6215
Practice Address - Street 1:7225 NW 25TH ST
Practice Address - Street 2:SUITE 217
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1706
Practice Address - Country:US
Practice Address - Phone:786-800-8376
Practice Address - Fax:305-477-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68512208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7868008376OtherCOMMERCIAL INSURANCES