Healthcare Provider Details

I. General information

NPI: 1710322946
Provider Name (Legal Business Name): SUN ELECTRONIC BRACHYTHERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E BROADWAY RD SUITE 104 & 105
MESA AZ
85206-1750
US

IV. Provider business mailing address

8380 W EMILE ZOLA AVE SUITE 5115
PEORIA AZ
85381-4811
US

V. Phone/Fax

Practice location:
  • Phone: 602-802-8700
  • Fax: 602-802-8799
Mailing address:
  • Phone: 602-802-8700
  • Fax: 602-802-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35361
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number28033
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number30940
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28033
License Number StateAZ

VIII. Authorized Official

Name: DR. MANNTEJ SINGH SRA
Title or Position: OWNER
Credential: MD
Phone: 602-705-1353