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General NPI Number Information
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NPI Number | 1891029963
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Entity Type | Organization
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Legal Business Name | SUNRISE MEDICAL CLINIC PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 5017 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-8080
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Country | US
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Telephone | 956-627-2414
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Fax | 956-627-2076
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Provider Business Mailing Address
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Address Line | PO BOX 2764
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City | MCALLEN
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State | TX
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Zip | 78502-2764
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. RAJEEV KUMAR MATHAVAN
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Credential | M.D.
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Telephone | 956-310-2439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N0953
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | N0953
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | N0953
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License Number State | TX
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