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General NPI Number Information
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NPI Number | 1780717207
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 2240 E LINCOLN AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2487
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Country | US
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Telephone | 509-837-6681
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Fax | 509-839-0075
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Provider Business Mailing Address
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Address Line | 2240 E LINCOLN AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2487
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Country | US
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Telephone | 509-837-6681
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Fax | 509-839-0075
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Authorized Official
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Title or Position | RECEPTION/BILLING
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Name | MS. OLGA MEDELEZ
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Credential |
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Telephone | 509-837-6681
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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 | OP00001175
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License Number State | WA
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