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Organization
SULLIVAN MEDICAL CORPORATION
Active
Organization
SULLIVAN MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W SULLIVAN MD (VICE-PRESIDENT)
(909) 985-1891
Entity
Organization
Contact information
Practice address
1175 E ARROW HIGHWAY SUITE B, UPLAND, CA 91786
(909) 985-1891
(909) 985-0121
Mailing address
1175 E ARROW HIGHWAY SUITE B, UPLAND, CA 91786
(909) 985-1891
(909) 985-0121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A199910
—
CA
Enumeration date
09/15/2006
Last updated
08/22/2020
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