Provider Demographics
NPI:1588758411
Name:SUNLAND MEDICAL GROUP,INC
Entity type:Organization
Organization Name:SUNLAND MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-352-3146
Mailing Address - Street 1:7709 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2120
Mailing Address - Country:US
Mailing Address - Phone:818-352-3146
Mailing Address - Fax:818-352-8116
Practice Address - Street 1:7709 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2120
Practice Address - Country:US
Practice Address - Phone:818-352-3146
Practice Address - Fax:818-352-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100020Medicaid
CAW18496OtherMEDICARE PTAN
CAGR0100020Medicaid
CAW18496Medicare PIN