Healthcare Provider Details

I. General information

NPI: 1922170976
Provider Name (Legal Business Name): PAUL RAYMOND SLOBODNY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 GEARY BLVD
SAN FRANCISCO CA
94115-3305
US

IV. Provider business mailing address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-4356
  • Fax:
Mailing address:
  • Phone: 510-454-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number530007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: