Provider Demographics
NPI:1780728642
Name:SUNNYSIDE FAMILY HEALTH LLC
Entity type:Organization
Organization Name:SUNNYSIDE FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERAS POLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-464-8883
Mailing Address - Street 1:3645 WILLIAMS BLVD
Mailing Address - Street 2:#104
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3464
Mailing Address - Country:US
Mailing Address - Phone:504-464-8883
Mailing Address - Fax:
Practice Address - Street 1:3645 WILLIAMS BLVD
Practice Address - Street 2:#104
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3464
Practice Address - Country:US
Practice Address - Phone:504-464-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15344R208000000X
LA201033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty