Provider Demographics
NPI:1972973014
Name:SUNSET SURGERY AND WOUND CARE LLC
Entity Type:Organization
Organization Name:SUNSET SURGERY AND WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-307-9889
Mailing Address - Street 1:105 PASEO CONCEPCION DE GRACIA
Mailing Address - Street 2:APT 804
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2621
Mailing Address - Country:US
Mailing Address - Phone:787-307-9889
Mailing Address - Fax:939-697-8064
Practice Address - Street 1:105 PASEO CONCEPCION DE GRACIA
Practice Address - Street 2:APT 804
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2621
Practice Address - Country:US
Practice Address - Phone:787-307-9889
Practice Address - Fax:939-697-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR178772083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty