Healthcare Provider Details

I. General information

NPI: 1154255933
Provider Name (Legal Business Name): NATHAN SEAN SLAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W SAN BERNARDINO RD
COVINA CA
91722-3621
US

IV. Provider business mailing address

550 W ALLEN AVE
SAN DIMAS CA
91773-1468
US

V. Phone/Fax

Practice location:
  • Phone: 562-706-4971
  • Fax:
Mailing address:
  • Phone: 626-541-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: