Provider Demographics
NPI:1205257698
Name:SULLIVAN, VENICE (CNMT)
Entity type:Individual
Prefix:
First Name:VENICE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 FAIR OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7051
Mailing Address - Country:US
Mailing Address - Phone:916-965-6558
Mailing Address - Fax:916-844-0286
Practice Address - Street 1:9801 FAIR OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7051
Practice Address - Country:US
Practice Address - Phone:916-965-6558
Practice Address - Fax:916-844-0286
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist