Healthcare Provider Details

I. General information

NPI: 1972090090
Provider Name (Legal Business Name): STACIA SLOANE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 CARLETON ST
BERKELEY CA
94702-2207
US

IV. Provider business mailing address

1217 CARLETON ST
BERKELEY CA
94702-2207
US

V. Phone/Fax

Practice location:
  • Phone: 510-290-4553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A19206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: