Healthcare Provider Details

I. General information

NPI: 1861067985
Provider Name (Legal Business Name): BRYAN SLOOTSKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MABLE AVE
MODESTO CA
95355-1119
US

IV. Provider business mailing address

2363 LE CONTE AVE UNIT B
BERKELEY CA
94709-1361
US

V. Phone/Fax

Practice location:
  • Phone: 209-857-3400
  • Fax:
Mailing address:
  • Phone: 561-702-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A23790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: