NPIMap

Organization Active NPI

Sunrise Health & Wellness Center, LLC

  • Addiction Medicine (Family Medicine) Physician
  • Rancho Cordova, CA
National Provider Identifier
1952809592
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
G54133 Issued in CA
Legal business name
SUNRISE HEALTH & WELLNESS CENTER, LLC
Practice address
10089 Folsom Blvd. Suites a & C
Rancho Cordova, CA 95670-1935
Phone
(916) 366-6531
NPI assigned
Jan 29, 2018
Last updated
Oct 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Authorized official

Name
Ernest VastiNPI 1205869849
Title
Owner
Phone
(209) 463-0891

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0401X G54133 CA Primary

Addresses

Primary practice location

10089 Folsom Blvd. Suites a & C
Rancho Cordova, CA 95670-1935

Mailing address

PO Box 4057
Stockton, CA 95204-0057

Other practice location 1

10089 Folsom Blvd Ste A
Rancho Cordova, CA 95670-1935
Phone (209) 463-0891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Opioid treatment program
Medicare-enrolled since May 9, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200504001427 CA Part B Supplier - Opioid Treatment Program (Otp) 5193156347 Practice locations: Rancho Cordova, CA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

10089 Folsom Blvd
#A
Rancho Cordova, CA 95670
Phone (916) 366-6531

10089 Folsom Blvd
Ste A
Rancho Cordova, CA 95670
Phone (916) 366-6531

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1952809592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4057",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952040057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10089 FOLSOM BLVD. SUITES A & C",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956701935",
            "telephone_number": "916-366-6531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10089 Folsom Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Rancho Cordova",
            "state": "CA",
            "postal_code": "956701935",
            "country_code": "US",
            "telephone_number": "209-463-0891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUNRISE HEALTH & WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-29",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "VASTI",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-463-0891"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G54133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cordova, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.