Provider Demographics
NPI:1073167813
Name:MATTHEW SCHULTZEL DO AND DOUGLAS SULLIVAN PC
Entity Type:Organization
Organization Name:MATTHEW SCHULTZEL DO AND DOUGLAS SULLIVAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-319-0712
Mailing Address - Street 1:2211 ENCINITAS BLVD STE 200
Mailing Address - Street 2:ATTN: DOUGLAS SULLIVAN
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 LAS COLINAS BLVD W STE 1650
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-5436
Practice Address - Country:US
Practice Address - Phone:626-319-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare