NPIMap

Organization Active NPI

Sunrise Intracoastal Plastic Surgery Center PA

  • Ambulatory Surgical Clinic/Center
  • Fort Lauderdale, FL
National Provider Identifier
1558008599
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SUNRISE INTRACOASTAL PLASTIC SURGERY CENTER PA
Doing business as
Sunrise Intracoastal Plastic Surgery Center PA
Practice address
910 NE 26TH Ave
Fort Lauderdale, FL 33304-3607
Phone
(954) 533-8029
NPI assigned
May 19, 2022
Last updated
May 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Juana De la Garza
Title
Authorized Official
Phone
(549) 147-5499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

910 NE 26TH Ave
Fort Lauderdale, FL 33304-3607

Mailing address

910 NE 26TH Ave
Fort Lauderdale, FL 33304-3607
Phone (954) 533-8029

Other identifiers 1

IdentifierTypeStateIssuer
OSR105OtherFLSTATE LICENSE

Other names 1

  • Sunrise Intracoastal Plastic Surgery Center PA Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1558008599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 NE 26TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043607",
            "telephone_number": "954-533-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 NE 26TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043607",
            "telephone_number": "954-533-8029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE INTRACOASTAL PLASTIC SURGERY CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-19",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "DE LA GARZA",
        "authorized_official_first_name": "JUANA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "549-147-5499"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OSR105",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Intracoastal Plastic Surgery Center PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.