Healthcare Provider Details

I. General information

NPI: 1710145263
Provider Name (Legal Business Name): AILEEN SLIVKOFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD 316
NEWPORT BEACH CA
92663-3509
US

IV. Provider business mailing address

351 HOSPITAL RD 316
NEWPORT BEACH CA
92663-3509
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-5775
  • Fax: 949-642-2037
Mailing address:
  • Phone: 949-642-5775
  • Fax: 949-642-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number533797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: