Healthcare Provider Details

I. General information

NPI: 1902631914
Provider Name (Legal Business Name): THREE SUNS BIRTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S LEA AVE
ROSWELL NM
88203-4564
US

IV. Provider business mailing address

3000 BANDOLINA AVE
ROSWELL NM
88201-6610
US

V. Phone/Fax

Practice location:
  • Phone: 575-416-5203
  • Fax: 575-616-7006
Mailing address:
  • Phone: 575-416-5203
  • Fax: 575-616-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN PULTS
Title or Position: CLINICAL DIRECTOR
Credential: CPM, LM
Phone: 575-416-5203