Healthcare Provider Details

I. General information

NPI: 1518931385
Provider Name (Legal Business Name): SUNRISE PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109
US

IV. Provider business mailing address

3196 S MARYLAND PKWY SUITE 101
LAS VEGAS NV
89109
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-8115
  • Fax: 702-784-7844
Mailing address:
  • Phone: 702-731-8099
  • Fax: 702-731-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2000403 543
License Number StateNV

VIII. Authorized Official

Name: DAN PERRITT
Title or Position: CFO
Credential:
Phone: 702-731-8012