Healthcare Provider Details

I. General information

NPI: 1629423132
Provider Name (Legal Business Name): VICTOR SLUPSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

150 W CIVIC CENTER DR STE 200
SANDY UT
84070-4284
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax:
Mailing address:
  • Phone: 888-854-3822
  • Fax: 770-701-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA144720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: