Provider Demographics
NPI:1336249606
Name:SUNNY MEDICAL PL, LLC.
Entity Type:Organization
Organization Name:SUNNY MEDICAL PL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-850-0103
Mailing Address - Street 1:11183 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 204D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9402
Mailing Address - Country:US
Mailing Address - Phone:407-850-0103
Mailing Address - Fax:407-850-9901
Practice Address - Street 1:11183 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 204D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9402
Practice Address - Country:US
Practice Address - Phone:407-850-0103
Practice Address - Fax:407-850-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70141Medicare UPIN
FLK3806Medicare PIN