Individual
LISA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
252 CALIFORNIA CT, MISSION VIEJO, CA 92692-4098
(949) 697-9228
Mailing address
252 CALIFORNIA CT, MISSION VIEJO, CA 92692-4098
(949) 697-9228
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA2143
CA
Other
Enumeration date
09/02/2012
Last updated
09/02/2012
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