Healthcare Provider Details

I. General information

NPI: 1962348789
Provider Name (Legal Business Name): JULIA SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 OTAY LAKES RD
CHULA VISTA CA
91913-1364
US

IV. Provider business mailing address

2060 OTAY LAKES RD
CHULA VISTA CA
91913-1364
US

V. Phone/Fax

Practice location:
  • Phone: 616-546-0039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: