Provider Demographics
NPI:1215448949
Name:SUTHERLAND, DERRICK G (EDD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:G
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 CATOCTIN DR APT 57
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2657
Mailing Address - Country:US
Mailing Address - Phone:619-648-9038
Mailing Address - Fax:
Practice Address - Street 1:433 TURK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3329
Practice Address - Country:US
Practice Address - Phone:415-928-7800
Practice Address - Fax:415-928-7310
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist