Healthcare Provider Details

I. General information

NPI: 1770038408
Provider Name (Legal Business Name): SUNITA M RAJPUT DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SUN AVE NE SUITE 650
ALBUQUERQUE NM
87109-4659
US

IV. Provider business mailing address

8100 WYOMING BLVD NE SUITE M4, BOX 384
ALBUQUERQUE NM
87113-1946
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-6784
  • Fax: 505-837-4610
Mailing address:
  • Phone: 505-835-6784
  • Fax: 505-837-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA152809
License Number StateNM

VIII. Authorized Official

Name: DR. SUNITA M RAJPUT
Title or Position: PRESIDENT
Credential: DO
Phone: 505-835-6784