Healthcare Provider Details

I. General information

NPI: 1265246029
Provider Name (Legal Business Name): SAMUEL SLOWN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 715
BERKELEY CA
94705-2122
US

IV. Provider business mailing address

2999 REGENT ST STE 715
BERKELEY CA
94705-2122
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-8700
  • Fax: 925-779-3705
Mailing address:
  • Phone: 925-323-5173
  • Fax: 925-779-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: