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General NPI Number Information
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NPI Number | 1902631914
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Entity Type | Organization
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Legal Business Name | THREE SUNS BIRTH
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 406 S LEA AVE
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City | ROSWELL
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State | NM
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Zip | 88203-4564
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Country | US
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Telephone | 575-416-5203
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Fax | 575-616-7006
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Provider Business Mailing Address
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Address Line | 3000 BANDOLINA AVE
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City | ROSWELL
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State | NM
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Zip | 88201-6610
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Country | US
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Telephone | 575-416-5203
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Fax | 575-616-7006
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KAITLYN PULTS
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Credential | CPM, LM
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Telephone | 575-416-5203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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