Individual
MS. TERRI ANN SULLIVAN-MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1723 W BALL RD, ANAHEIM, CA 92804-5502
(714) 635-0363
Mailing address
9888 RAVARI DR, CYPRESS, CA 90630-3553
(714) 827-1327
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA11279
CA
Other
Enumeration date
02/04/2007
Last updated
07/08/2007
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