Provider Demographics
NPI:1528303153
Name:SUN & SURF MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:SUN & SURF MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLFO
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:361-537-3605
Mailing Address - Street 1:PO BOX 271018
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14254 S PADRE ISLAND DR STE 207
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6278
Practice Address - Country:US
Practice Address - Phone:361-537-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-08
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677578261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center