| Doctor Name: | DR. ANDREW SULLIVAN |
| NPI Number: | 1932470291 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 0102203574 |
| Business Practice Address: | 162 1st St Bldg 1402 Port Hueneme, CA - 930434316 |
| Business Phone Number: | 9365230454 |
| Business Fax Number: | 8059822071 |
| Mailing Address: | 162 1st St Bldg 1402, PORT HUENEME |
| State: | CA |
| Postal Code: | 930434316 |
| Phone Number: | 9365230454 |
| Fax Number: | 8059822071 |
| NPI Enumeration Date: | 01/19/2012 |
| NPI Last Update Date: | 04/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0102203574 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |