Healthcare Provider Details

I. General information

NPI: 1538521125
Provider Name (Legal Business Name): RANDAL SLOOP MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 TALBERT DR STE 150
CHICO CA
95928-7723
US

IV. Provider business mailing address

2068 TALBERT DR STE 150
CHICO CA
95928-7723
US

V. Phone/Fax

Practice location:
  • Phone: 530-809-0009
  • Fax: 530-809-0399
Mailing address:
  • Phone: 530-809-0009
  • Fax: 530-809-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG61004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG63549
License Number StateCA

VIII. Authorized Official

Name: RANDAL SLOOP
Title or Position: PRESIDENT
Credential: MD
Phone: 530-809-0009