Individual
DR. LESLIE A SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2040 FOREST AVE, SUITE 2, SAN JOSE, CA 95128-4810
(408) 732-1957
(408) 298-9838
Mailing address
10460 MADERA DR, CUPERTINO, CA 95014-1134
(408) 356-0683
(408) 298-9838
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G69219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G692190
—
CA
Enumeration date
07/14/2006
Last updated
11/02/2007
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