Individual
DAVID STEVEN SULIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3714 TIBBETTS ST, SUITE 104, RIVERSIDE, CA 92506-2661
(951) 367-6702
(951) 367-7789
Mailing address
3714 TIBBETTS ST., SUITE 104, RIVERSIDE, CA 92506-3020
(951) 367-6702
(951) 367-7789
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
C22175
CA
335E00000X
Prosthetic/Orthotic Supplier
Primary
CP002649
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMS168487
CCS
CA
05
—
XA0029550
—
CA
Enumeration date
11/13/2007
Last updated
10/01/2009
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