Basic Information
| Provider Information | |||||||||
| NPI: | 1225776347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUN HEALTH WEIGHT LOSS AND WELLNESS PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRIMARY HEALTH COPPELL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 S STATE HIGHWAY 121 N STE 100 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750193988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723825761 | ||||||||
| FaxNumber: | 9729541734 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 S STATE HIGHWAY 121 N STE 100 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750193988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723825761 | ||||||||
| FaxNumber: | 9729541734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2022 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | MALLA | ||||||||
| AuthorizedOfficialFirstName: | SUNITHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8178973787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.