Basic Information
| Provider Information | |||||||||
| NPI: | 1255995387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUN CITY NEUROMUSCULAR REHABILITATION PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9318 HOKE DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782542224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154432585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1395 GEORGE DIETER DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799367499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152987222 | ||||||||
| FaxNumber: | 9152987298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2019 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAHABI AZAD | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9154432585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.