Basic Information
Provider Information | |||||||||
NPI: | 1326161548 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SUNRISE MEDICAL MANAGEMENT LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13634 N 93RD AVE | ||||||||
Address2: | #100 | ||||||||
City: | PEORIA | ||||||||
State: | AZ | ||||||||
PostalCode: | 85381 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6239330301 | ||||||||
FaxNumber: | 6239330224 | ||||||||
Practice Location | |||||||||
Address1: | 13634 N. 93RD AVE | ||||||||
Address2: | #100 | ||||||||
City: | PEORIA | ||||||||
State: | AZ | ||||||||
PostalCode: | 85381 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6239330301 | ||||||||
FaxNumber: | 6239330224 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2007 | ||||||||
LastUpdateDate: | 03/04/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MEHTA | ||||||||
AuthorizedOfficialFirstName: | GIRISH | ||||||||
AuthorizedOfficialMiddleName: | H | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 6239330301 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 03/04/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22557 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RP1001X | 18499 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.