Individual
MARY P. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2500 MERCED STREET, SAN LEANDRO, CA 94577-4201
(510) 454-1000
Mailing address
2500 MERCED STREET, SAN LEANDRO, CA 94577-4201
(510) 454-1000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
399866
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
399866
AMDIETETICASSOC REGIST#
—
Enumeration date
12/12/2006
Last updated
07/31/2015
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