Healthcare Provider Details

I. General information

NPI: 1164055927
Provider Name (Legal Business Name): SUNRISE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

117 CAMINO DE VIDA
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDAL W BROWN
Title or Position: CEO
Credential: MD
Phone: 575-472-4311