Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE MARY SULLIVAN RN, MFT (ADVICE NURSE)
(619) 221-6107
Entity
Organization
Contact information
Practice address
3420 KENYON ST, SAN DIEGO, CA 92110-5001
(619) 221-6107
Mailing address
3420 KENYON ST, SAN DIEGO, CA 92110-5001
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
F219608
CA
Other
Enumeration date
06/19/2007
Last updated
07/10/2008
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