Individual
JOAN GRANT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1749 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94709-2139
(510) 841-8484
Mailing address
1749 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94709-2139
(510) 841-8484
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C23284
CA
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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