Healthcare Provider Details

I. General information

NPI: 1407422645
Provider Name (Legal Business Name): GLORIA SLAVINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA CHOI

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: