Healthcare Provider Details

I. General information

NPI: 1871674226
Provider Name (Legal Business Name): KRISTINA ROSE SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVENUE
SAN FRANCISCO CA
94115
US

IV. Provider business mailing address

2872 JACKSON ST
SAN FRANCISCO CA
94115-1146
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1212
  • Fax:
Mailing address:
  • Phone: 415-203-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA72873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: