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NPI Code Detail

MEDICARE: SUNRISE HEALTH CLINICS LLC

MEDICARE: SUNRISE HEALTH CLINICS LLC
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
12084A0401XAddiction Medicine (Psychiatry & Neurology) Physician
2251S00000XCommunity/Behavioral Health Agency
32083P0901XPublic Health & General Preventive Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NV20141642973OTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1629405840
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE HEALTH CLINICS LLC
Provider Business Mailing Address
First Line : 6767 W TROPICANA AVE STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-4755
Country : US
Telephone Number : 702-209-0370
Fax Number : 702-463-1851
Provider Business Practice Location Address
First Line : 6767 W TROPICANA AVE STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-4755
Country : US
Telephone Number : 702-209-0370
Fax Number : 702-463-1851
Authorized Official
Title or Position : OWNER
Name : BESCHELLE JUANMIA LOCKHART
Credential :
Telephone Number : 702-209-0370
Provider Enumeration Date : 10/02/2013
Last Update Date : 03/07/2024

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Directions to “SUNRISE HEALTH CLINICS LLC ” Practice Location

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