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General NPI Number Information
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NPI Number | 1699147611
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Entity Type | Organization
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Legal Business Name | SUN PRIMARY CARE CLINIC, PLLC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 4747 BELLAIRE BLVD SUITE 101
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City | BELLAIRE
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State | TX
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Zip | 77401-4527
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Country | US
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Telephone | 832-780-9598
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Fax | 206-666-4377
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Provider Business Mailing Address
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Address Line | 10731 LONGMONT DR
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City | HOUSTON
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State | TX
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Zip | 77042-2311
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Country | US
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Telephone | 713-242-1248
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Fax | 206-666-4377
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ALI GHAZAVI
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Credential | ANP
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Telephone | 281-818-8448
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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 | 773335
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License Number State | TX
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