Healthcare Provider Details

I. General information

NPI: 1932143765
Provider Name (Legal Business Name): DAVID SLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W EL NORTE PKWY
ESCONDIDO CA
92026-3923
US

IV. Provider business mailing address

PO BOX 969096
SAN DIEGO CA
92196-9096
US

V. Phone/Fax

Practice location:
  • Phone: 760-738-7830
  • Fax: 760-738-7834
Mailing address:
  • Phone: 858-495-0971
  • Fax: 858-495-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG36344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: