Provider Demographics
NPI:1053662924
Name:SULLIVAN, WILLIAM CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FIRE AUTHORITY RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0125
Mailing Address - Country:US
Mailing Address - Phone:949-205-6129
Mailing Address - Fax:
Practice Address - Street 1:1 FIRE AUTHORITY RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0125
Practice Address - Country:US
Practice Address - Phone:949-205-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant