Provider Demographics
NPI:1689241002
Name:SUNRISE MEDICAL GROUP OF IMPERIAL VALLEY
Entity Type:Organization
Organization Name:SUNRISE MEDICAL GROUP OF IMPERIAL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:760-975-5305
Mailing Address - Street 1:1671 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-5420
Mailing Address - Country:US
Mailing Address - Phone:760-592-7760
Mailing Address - Fax:
Practice Address - Street 1:1671 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-5420
Practice Address - Country:US
Practice Address - Phone:760-622-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty