Individual
KEVIN BRIAN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(970) 640-5914
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
1194245662
CA
207P00000X
Emergency Medicine Physician
Primary
20A18937
CA
Other
Enumeration date
06/26/2017
Last updated
08/06/2021
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