Provider Demographics
NPI:1447422357
Name:MEGAN SULLAWAY AND EDWARD DUNBAR
Entity Type:Organization
Organization Name:MEGAN SULLAWAY AND EDWARD DUNBAR
Other - Org Name:PACIFIC PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-536-0211
Mailing Address - Street 1:877 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2801
Mailing Address - Country:US
Mailing Address - Phone:310-536-0211
Mailing Address - Fax:310-536-0215
Practice Address - Street 1:877 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2801
Practice Address - Country:US
Practice Address - Phone:310-536-0211
Practice Address - Fax:310-536-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9947Medicare PIN