Active NPI
Andrew Sullivan, D.O.
- General Practice Physician
- Port Hueneme, CA
National Provider Identifier
1932470291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0102203574
- Practice address
- 162 1St St BLDG 1402
Port Hueneme, CA 93043-4316 - Phone
- (936) 523-0454
- Fax
- (805) 982-2071
- NPI assigned
- Jan 19, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0102203574 | VA | Primary |
Addresses
Primary practice location
162 1St St BLDG 1402
Port Hueneme, CA 93043-4316
Mailing address
162 1St St BLDG 1402
Port Hueneme, CA 93043-4316
Phone (936) 523-0454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102203574 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429747200000",
"number": "1932470291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "162 1ST ST BLDG 1402",
"city": "PORT HUENEME",
"state": "CA",
"postal_code": "930434316",
"telephone_number": "936-523-0454",
"fax_number": "805-982-2071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 1ST ST BLDG 1402",
"city": "PORT HUENEME",
"state": "CA",
"postal_code": "930434316",
"telephone_number": "936-523-0454",
"fax_number": "805-982-2071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-19",
"last_updated": "2015-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0102203574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Hueneme, CA
- Donald Kenneth Steensma, O.D.
- Steven G. Johnson Dental Corporation (Johnson Family Dental)
- Brian Michael Strahl, IDC
- Barbara Ruth Strong Doreo, DC MS
- Katie Marie Sugar, DMD
- Tariq H.Alsamaan D.D.S.Dental Corp
- Stephanie Teitsort, CMT/LMT
- Regina Tellez, LVN
- Thrifty Payless Inc (Rite Aid Pharmacy 05782)
- Trucare Non-Emergency Transportation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.