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General NPI Number Information
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NPI Number | 1811866437
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 1614 E EDISON AVE STE F
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City | SUNNYSIDE
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State | WA
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Zip | 98944-1668
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Country | US
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Telephone | 509-388-4686
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Fax |
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Provider Business Mailing Address
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Address Line | 409 EMERALD AVE
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City | GRANDVIEW
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State | WA
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Zip | 98930-6101
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Country | US
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Telephone | 509-388-4686
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Fax |
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Authorized Official
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Title or Position | OWER
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Name | MANUEL JIMENEZ
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Credential | PHYSICIAN ASSISTANT
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Telephone | 509-388-4686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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