MEDICARE: SUNSET COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1700356292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	675 S AVENUE B BLDG B
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-2749
Country	:	US
Telephone Number	:	928-819-8999
Fax Number	:	928-539-5579

Provider Business Practice Location Address
First Line	:	675 S AVENUE B BLDG B
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-2749
Country	:	US
Telephone Number	:	928-819-8999
Fax Number	:	928-539-5579

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT CREDENTIAL
Name	:	LUISANA MEDINA
Credential	:
Telephone Number	:	928-819-8834

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	08/12/2024

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