Healthcare Provider Details

I. General information

NPI: 1538780259
Provider Name (Legal Business Name): DAWN DENEA SULLIVAN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CENTER DR STE E
LA MESA CA
91942-2952
US

IV. Provider business mailing address

921 N 1ST ST
EL CAJON CA
92021-4834
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-6077
  • Fax:
Mailing address:
  • Phone: 619-672-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number42477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: