MEDICARE: STEPHANIE 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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376492959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SULLIVAN

Provider Business Mailing Address
First Line	:	4001 MISSION OAKS BLVD STE I
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5121
Country	:	US
Telephone Number	:	805-850-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 MISSION OAKS BLVD STE I
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5121
Country	:	US
Telephone Number	:	805-850-4570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	02/02/2026

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