Healthcare Provider Details

I. General information

NPI: 1265488167
Provider Name (Legal Business Name): ZINA DANIELLE SLOAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LOOP
FT IRWIN CA
92310
US

IV. Provider business mailing address

4 LOOP MEDDAC MEWC; GOLD TEAM
FT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-6278
  • Fax: 760-380-4409
Mailing address:
  • Phone: 760-380-6278
  • Fax: 760-380-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: