Provider Demographics
NPI:1912059213
Name:SULLIVAN, MEGGIN B (OMD)
Entity Type:Individual
Prefix:DR
First Name:MEGGIN
Middle Name:B
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:544 W VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-639-6471
Mailing Address - Fax:760-639-6482
Practice Address - Street 1:400 S MELROSE DR
Practice Address - Street 2:STE 111
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6632
Practice Address - Country:US
Practice Address - Phone:760-806-4347
Practice Address - Fax:760-806-4348
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist