Healthcare Provider Details

I. General information

NPI: 1619361987
Provider Name (Legal Business Name): JOHN SLENTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 17TH ST
OAKLAND CA
94612-1553
US

IV. Provider business mailing address

124 KELTON AVE
SAN CARLOS CA
94070-4743
US

V. Phone/Fax

Practice location:
  • Phone: 510-318-7125
  • Fax:
Mailing address:
  • Phone: 650-346-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number495611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: