# SUNRISE PHYSICIAN SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295767408
- **Authorized official:** JIMMY BURNETT (VP)
- **Authorized official phone:** (702) 262-9676

## Contact information

- **Practice address:** 3186 S MARYLAND PKWY, LAS VEGAS, NV 89109-2317
- **Practice address phone:** (702) 262-9676
- **Mailing address:** 3186 S MARYLAND PKWY, LAS VEGAS, NV 89109-2317
- **Mailing address phone:** (702) 262-9676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100501944 | — | NV |
| 05 | — | 915019 | — | AZ |
| 01 | — | CC8707 | BCBS | NV |
| 05 | — | XGG007680 | — | CA |