Provider Demographics
NPI:1649316332
Name:SULLIVAN, NEIL PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STATE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2429
Mailing Address - Country:US
Mailing Address - Phone:805-617-7858
Mailing Address - Fax:
Practice Address - Street 1:915 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2331
Practice Address - Country:US
Practice Address - Phone:805-963-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-21441207Q00000X
CAC39620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C396200Medicaid
CAC39620OtherPHYSICIAN LICENSE
CAC39620OtherPHYSICIAN LICENSE
CABS7560039OtherDEA NUMBER
CABS7627182OtherDEA NUMBER
CABS7560039OtherDEA NUMBER
CAC39620OtherPHYSICIAN LICENSE