Healthcare Provider Details

I. General information

NPI: 1629405840
Provider Name (Legal Business Name): SUNRISE HEALTH CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4755
US

IV. Provider business mailing address

6767 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4755
US

V. Phone/Fax

Practice location:
  • Phone: 702-209-0370
  • Fax: 702-463-1851
Mailing address:
  • Phone: 702-209-0370
  • Fax: 702-463-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BESCHELLE JUANMIA LOCKHART
Title or Position: OWNER
Credential:
Phone: 702-209-0370