Healthcare Provider Details

I. General information

NPI: 1730291675
Provider Name (Legal Business Name): STUART SLAVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #265
LOS ANGELES CA
90074
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6923
  • Fax: 310-394-7807
Mailing address:
  • Phone: 310-828-7172
  • Fax: 310-394-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG54766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG54766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: