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General NPI Number Information
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NPI Number | 1093503963
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Entity Type | Organization
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Legal Business Name | SUNNYVALE FAMILY CLINIC LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3030 TOWNE CENTRE DR STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-4134
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Country | US
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Telephone | 469-691-2288
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Fax | 469-691-2289
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Provider Business Mailing Address
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Address Line | 3030 TOWNE CENTRE DR STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-4134
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Country | US
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Telephone | 469-691-2288
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Fax | 469-691-2289
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Authorized Official
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Title or Position | OWNER
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Name | JAISY RAJU
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Credential | APRN, FNP-BC
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Telephone | 469-691-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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