Healthcare Provider Details

I. General information

NPI: 1053751271
Provider Name (Legal Business Name): ROBERT EDWIN O' SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71943 HIGHWAY 111
RANCHO MIRAGE CA
92270-4848
US

IV. Provider business mailing address

71943 HIGHWAY 111
RANCHO MIRAGE CA
92270-4848
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7982
  • Fax: 760-834-7981
Mailing address:
  • Phone: 760-834-7982
  • Fax: 760-834-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC209010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number55690
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: