Provider Demographics
NPI:1780363655
Name:SULLIVAN, DANIEL PATRICK JR
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 ROWAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5634
Mailing Address - Country:US
Mailing Address - Phone:619-538-6053
Mailing Address - Fax:
Practice Address - Street 1:4484 PACIFIC COAST HWY.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-772-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist