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NPI Code Detail

MEDICARE: MAGGIE SULLIVAN

MEDICARE:   MAGGIE  SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-23-300890CA

General Provider Information

NPI Number : 1013797513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAGGIE SULLIVAN
Provider Business Mailing Address
First Line : 7027 CAMINO DEGRAZIA UNIT 208
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-7811
Country : US
Telephone Number : 619-727-3926
Fax Number :
Provider Business Practice Location Address
First Line : 7027 CAMINO DEGRAZIA UNIT 208
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-7811
Country : US
Telephone Number : 619-727-3926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2023
Last Update Date : 10/02/2023

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Directions to “ MAGGIE SULLIVAN ” Practice Location

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