Individual
MRS. KATHY REBECCA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
MSRON FIVE MEDICAL DEPARTMENT, NOLF IB BUILDING 169, SAN DIEGO, CA 92135
(619) 437-9382
Mailing address
MSRON FIVE MEDICAL DEPARTMENT, NOLF IB BUILDING 169, SAN DIEGO, CA 92135
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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