Individual
DR. KATHLEEN BEATRICE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
24451 HEALTH CENTER DR, LAGUNA HILLS, CA 92653-3689
(949) 837-4500
(949) 837-4621
Mailing address
PO BOX 10429, NEWPORT BEACH, CA 92658-0429
(949) 417-1812
(949) 417-1803
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G49346
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G493460
BLUE SHIELD ID #
CA
05
—
00G493460
—
CA
01
—
00G493460385
CALOPTIMA ID #
CA
Enumeration date
07/27/2006
Last updated
07/09/2007
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