Organization
SUNRISE MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA SANCHEZ DIRECTOR (CREDENTIALING)
(575) 472-4311
Entity
Organization
Contact information
Practice address
552 HIGHWAY 54, SANTA ROSA, NM 88435-2215
(505) 433-5572
(877) 651-1259
Mailing address
552 HIGHWAY 54, SANTA ROSA, NM 88435-2215
(505) 433-5572
(877) 651-1259
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
6794
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00074686
—
NM
01
—
1124107446
GROUP NPI
NM
01
—
600521016
MEDICARE GROUP ID
—
01
—
6794
NM HEALTH DEPT. NO.
NM
Enumeration date
11/06/2006
Last updated
10/11/2023
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