Individual
SYDNEY ROSE GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2400 UNSER BLVD SE, STE 18200, RIO RANCHO, NM 87124-4740
(505) 563-6565
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0057
NM
363AM0700X
Medical Physician Assistant
PA2021-0057
NM
363AS0400X
Surgical Physician Assistant
PA2021-0057
NM
Other
Enumeration date
01/16/2020
Last updated
01/04/2024
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