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General NPI Number Information
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NPI Number | 1477733962
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Entity Type | Individual
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Provider Name | DAVID STEVEN SULIS CPO
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Gender | Male
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 3714 TIBBETTS ST SUITE 104
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City | RIVERSIDE
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State | CA
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Zip | 92506-2661
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Country | US
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Telephone | 951-367-6702
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Fax | 951-367-7789
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Provider Business Mailing Address
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Address Line | 3714 TIBBETTS ST. SUITE 104
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City | RIVERSIDE
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State | CA
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Zip | 92506-3020
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Country | US
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Telephone | 951-367-6702
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Fax | 951-367-7789
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | C22175
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CP002649
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License Number State | CA
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