Healthcare Provider Details

I. General information

NPI: 1316996283
Provider Name (Legal Business Name): SUNITA M RAJPUT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 2 ACC. MSC10 5615
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 716-863-1948
  • Fax:
Mailing address:
  • Phone: 716-863-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA-1528-09
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: