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General NPI Number Information
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NPI Number | 1780363655
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Entity Type | Individual
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Provider Name | MR. DANIEL PATRICK SULLIVAN JR.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 4484 PACIFIC COAST HWY.
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City | SAN DIEGO
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State | CA
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Zip | 92110
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Country | US
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Telephone | 619-772-6541
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 ROWAN ST
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City | SAN DIEGO
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State | CA
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Zip | 92105-5634
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Country | US
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Telephone | 619-538-6053
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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