Provider Demographics
NPI:1568876324
Name:SUN CITY KIDNEY, PA
Entity Type:Organization
Organization Name:SUN CITY KIDNEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REY
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-626-5548
Mailing Address - Street 1:1250 E CLIFF DR
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-626-5548
Mailing Address - Fax:915-626-5411
Practice Address - Street 1:1250 E CLIFF DR
Practice Address - Street 2:SUITE 3E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-626-5548
Practice Address - Fax:915-626-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1325207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033103080OtherNPI
TXH92359Medicare UPIN