MEDICARE: SUN CITY NEUROMUSCULAR REHABILITATION PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1255995387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN CITY NEUROMUSCULAR REHABILITATION PLLC

Provider Business Mailing Address
First Line	:	9318 HOKE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2224
Country	:	US
Telephone Number	:	915-443-2585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 JOE BATTLE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2619
Country	:	US
Telephone Number	:	915-910-6041
Fax Number	:	915-944-3198

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN SHAHABI AZAD
Credential	:	MD
Telephone Number	:	915-443-2585

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	07/03/2024

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