Healthcare Provider Details

I. General information

NPI: 1902301096
Provider Name (Legal Business Name): SUNSET MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 W THUNDERBIRD RD
GLENDALE AZ
85306-4836
US

IV. Provider business mailing address

PO BOX 406
LAVEEN AZ
85339-1798
US

V. Phone/Fax

Practice location:
  • Phone: 480-653-2341
  • Fax: 480-452-1335
Mailing address:
  • Phone: 602-509-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP10016
License Number StateAZ

VIII. Authorized Official

Name: MS. JODI OSTROM
Title or Position: OWNER
Credential: FNP-C
Phone: 602-509-9177