| Malin Sullivan, | |
|
225 N Jackson Ave, San Jose, CA 95116-1603 | |
| (408) 259-5000 | |
| Not Available |
| Full Name | Malin Sullivan |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 225 N Jackson Ave, San Jose, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518298249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 20730 (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Entity Name | Cep America - California |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023063542 PECOS PAC ID: 6103739131 Enrollment ID: O20031106000520 |
| Mailing Address | Practice Location Address |
|---|---|
| Malin Sullivan, 710 Del Valle, Aptos, CA 95003-9506 Ph: (831) 430-6426 | Malin Sullivan, 225 N Jackson Ave, San Jose, CA 95116-1603 Ph: (408) 259-5000 |
Amane Ali, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 2063 Forest Ave, San Jose, CA 95128 Phone: 408-280-2500 |
Beth L. Bratt, P.A-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 2425 Samaritan Drive, San Jose, CA 95124 Phone: 408-559-2011 |
Mr. Robert Chapa, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 751 S Bascom Ave, San Jose, CA 95128 Phone: 408-885-6912 |
Kassaundra Cervantes, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1071 Blossom Hill Rd, San Jose, CA 95123 Phone: 408-455-4010 |
Betsabeth Munoz Romo, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 195 E Virginia St, San Jose, CA 95112 Phone: 408-457-7100 |
Gary P D'aluisio, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 751 S Bascom Ave, Emergency Dept, San Jose, CA 95128 Phone: 408-885-5000 |
Madeleine Vo, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2425 Samaritan Dr, San Jose, CA 95124 Phone: 408-559-2011 |