MEDICARE: MATTHEW SCHULTZEL DO AND DOUGLAS SULLIVAN PC

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
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1073167813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW SCHULTZEL DO AND DOUGLAS SULLIVAN PC

Provider Business Mailing Address
First Line	:	2211 ENCINITAS BLVD STE 200
Second Line	:	ATTN: DOUGLAS SULLIVAN
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 LAS COLINAS BLVD W STE 1650
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-5436
Country	:	US
Telephone Number	:	626-319-0712
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	DOUGLAS SULLIVAN
Credential	:
Telephone Number	:	626-319-0712

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	09/12/2019

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