Healthcare Provider Details

I. General information

NPI: 1740504588
Provider Name (Legal Business Name): DAVID NEIL ZLOTNICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 TAYLOR BLVD STE 200
PLEASANT HILL CA
94523-2287
US

IV. Provider business mailing address

630 ENCINAL CT
WALNUT CREEK CA
94597-3166
US

V. Phone/Fax

Practice location:
  • Phone: 925-270-3575
  • Fax: 925-270-3589
Mailing address:
  • Phone: 152-902-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA143558
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA143558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: