Healthcare Provider Details

I. General information

NPI: 1700892437
Provider Name (Legal Business Name): LAURA SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7316 S. SETTLER DR.
MORRISON CO
80465
US

IV. Provider business mailing address

7316 S. SETTLER DR.
MORRISON CO
80465
US

V. Phone/Fax

Practice location:
  • Phone: 714-722-4688
  • Fax: 562-904-8095
Mailing address:
  • Phone: 714-722-4688
  • Fax: 562-920-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG55298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: