Provider Demographics
NPI:1922677319
Name:SUN CITY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SUN CITY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:442-271-4337
Mailing Address - Street 1:646 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-7914
Mailing Address - Country:US
Mailing Address - Phone:442-271-4337
Mailing Address - Fax:833-906-2293
Practice Address - Street 1:646 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-7914
Practice Address - Country:US
Practice Address - Phone:442-271-4337
Practice Address - Fax:833-906-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty