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Individual

TERRENCE R SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
16450 MATILIJA DR, LOS GATOS, CA 95030-3080
(408) 590-3159
Mailing address
16450 MATILIJA DR, LOS GATOS, CA 95030-3080
(408) 590-3159

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G25099
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00061715
RAILROAD MEDICARE
Enumeration date
09/01/2005
Last updated
10/24/2023
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