Healthcare Provider Details

I. General information

NPI: 1720178189
Provider Name (Legal Business Name): GLORIA JUNE SLATER-GARRETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W. WARNER AVE
SANTA ANA CA
92707
US

IV. Provider business mailing address

20224 MAPES AVE
CERRITOS CA
90703
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-6900
  • Fax: 714-437-9316
Mailing address:
  • Phone: 714-834-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 477574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: