NPIMap

Organization Active NPI

Sun City Dermatology, PA

  • Dermatology Physician
  • El Paso, TX
National Provider Identifier
1104988377
Registry record updated Sep 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M5195 Issued in TX
Legal business name
SUN CITY DERMATOLOGY, PA
Practice address
4545 N Mesa St
El Paso, TX 79912-6121
Phone
(915) 351-7546
Fax
(915) 351-3545
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Adrian Matthew Guevara, MD
Title
President
Phone
(915) 351-7546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X M5195 TX Primary

Addresses

Primary practice location

4545 N Mesa St
El Paso, TX 79912-6121

Mailing address

4545 N Mesa St
El Paso, TX 79912-6121
Phone (915) 351-7546

National Provider Directory

National Provider Directory

Locations

110 Mesa Park Dr
Ste 100
El Paso, TX 79912
Phone (915) 351-7546

310 S Mesa Hills Dr
Ste B
El Paso, TX 79912
Phone (915) 351-7546

4545 N Mesa St
El Paso, TX 79912
Phone (915) 351-7546

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1104988377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 N MESA ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799126121",
            "telephone_number": "915-351-7546",
            "fax_number": "915-351-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 N MESA ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799126121",
            "telephone_number": "915-351-7546",
            "fax_number": "915-351-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN CITY DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "GUEVARA",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-351-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M5195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.