Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 701 | CA |
NPI | 1124472600 |
---|---|
Provider Name | Dr. Gene Sullivan |
First Address | Santa Rosa, CA 95401-4462 |
Second Address | Santa Rosa, CA 95401-4462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 20/04/2016 |