NPI 1144579418

Lisa Sullivan

Practitioner Specialist Mission Viejo, CA

Practice location

Address: 252 California CT, Mission Viejo, CA 92692-4098
Phone: (949) 697-9228

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence OTA2143 (CA)

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Registry record

NPI: 1144579418
Entity type: Individual
Sex (as registered): Female
NPI issued: 2 Sep 2012
Record last updated: 2 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.