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General NPI Number Information
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NPI Number | 1124107446
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Entity Type | Organization
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Legal Business Name | SUNRISE MEDICAL GROUP, PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 552 HIGHWAY 54
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City | SANTA ROSA
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State | NM
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Zip | 88435-2215
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Country | US
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Telephone | 505-433-5572
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Fax | 877-651-1259
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Provider Business Mailing Address
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Address Line | 552 HIGHWAY 54
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City | SANTA ROSA
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State | NM
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Zip | 88435-2215
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Country | US
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Telephone | 505-433-5572
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Fax | 877-651-1259
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Authorized Official
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Title or Position | CREDENTIALING
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Name | JESSICA SANCHEZ
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Credential | DIRECTOR
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Telephone | 575-472-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 6794
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License Number State | NM
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