Healthcare Provider Details

I. General information

NPI: 1073810867
Provider Name (Legal Business Name): SUSAN SLOSING RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18711 W AVENUE E4
LANCASTER CA
93536-9050
US

IV. Provider business mailing address

18711 W AVENUE E4
LANCASTER CA
93536-9050
US

V. Phone/Fax

Practice location:
  • Phone: 661-714-0297
  • Fax: 661-724-3067
Mailing address:
  • Phone: 661-714-0297
  • Fax: 661-724-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: