Provider Demographics
NPI:1427091792
Name:SUNNY ISLAND COSMETIC SURGERY
Entity type:Organization
Organization Name:SUNNY ISLAND COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ETCHEVERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-932-9877
Mailing Address - Street 1:10700 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5507
Mailing Address - Country:US
Mailing Address - Phone:954-252-3305
Mailing Address - Fax:305-932-2098
Practice Address - Street 1:19495 BISCAYNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2318
Practice Address - Country:US
Practice Address - Phone:305-932-9877
Practice Address - Fax:305-932-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty