Healthcare Provider Details

I. General information

NPI: 1194408625
Provider Name (Legal Business Name): SUNRISE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S PACIFIC ST
LAS VEGAS NM
87701-3415
US

IV. Provider business mailing address

117 CAMINO DE VIDA STE 300
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-426-2599
  • Fax: 877-651-0289
Mailing address:
  • Phone: 575-472-4311
  • Fax: 877-651-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SANCHEZ
Title or Position: DIRECTOR OF HR
Credential:
Phone: 575-472-4311