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General NPI Number Information
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NPI Number | 1700993128
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Entity Type | Organization
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Legal Business Name | SUN CITY PEDIATRICS, PA
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11160 LA QUINTA PLACE
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City | EL PASO
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State | TX
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Zip | 79936-4122
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Country | US
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Telephone | 915-591-1494
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Fax | 915-598-0610
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Provider Business Mailing Address
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Address Line | 11160 LA QUINTA PLACE
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City | EL PASO
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State | TX
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Zip | 79936
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Country | US
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Telephone | 915-591-1494
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Fax | 915-598-0610
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMON COLON-DORDAL
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Credential | M.D.
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Telephone | 915-591-1494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J6968
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J6911
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License Number State | TX
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