Provider Demographics
NPI:1073496055
Name:SUNSET SPORTS MEDICINE
Entity type:Organization
Organization Name:SUNSET SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAFE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-204-0550
Mailing Address - Street 1:4838 E BASELINE RD STE 122
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4675
Mailing Address - Country:US
Mailing Address - Phone:480-204-0550
Mailing Address - Fax:
Practice Address - Street 1:4838 E BASELINE RD STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4675
Practice Address - Country:US
Practice Address - Phone:480-204-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty