Provider Demographics
NPI:1972529162
Name:SUNSHINE ANESTHESIA A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SUNSHINE ANESTHESIA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-846-1803
Mailing Address - Street 1:38069 MARTHA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3811
Mailing Address - Country:US
Mailing Address - Phone:510-744-9153
Mailing Address - Fax:510-744-9399
Practice Address - Street 1:38069 MARTHA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3811
Practice Address - Country:US
Practice Address - Phone:510-744-9153
Practice Address - Fax:510-744-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28782207L00000X, 207LP2900X
CAG27171207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G271710Medicaid
CA00G287820Medicaid
CAZZZ16285ZMedicare ID - Type Unspecified
CAA43858Medicare UPIN
CA00G271710Medicaid