Provider Demographics
NPI:1164633053
Name:SUN PACIFIC HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:SUN PACIFIC HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-213-4157
Mailing Address - Street 1:8501 CAMINO MEDIA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1354
Mailing Address - Country:US
Mailing Address - Phone:661-665-1800
Mailing Address - Fax:
Practice Address - Street 1:8501 CAMINO MEDIA
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1354
Practice Address - Country:US
Practice Address - Phone:661-665-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24224111N00000X
CAA65257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty