Healthcare Provider Details

I. General information

NPI: 1336694397
Provider Name (Legal Business Name): SUN CITY HOME IMPROVEMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11394 JAMES WATT DR STE 208
EL PASO TX
79936-6436
US

IV. Provider business mailing address

14980 DOE LN
EL PASO TX
79938-9078
US

V. Phone/Fax

Practice location:
  • Phone: 915-613-8454
  • Fax:
Mailing address:
  • Phone: 915-613-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: VICTOR DE LA ROSA
Title or Position: PRESIDENT
Credential:
Phone: 915-588-5640