Healthcare Provider Details

I. General information

NPI: 1407903354
Provider Name (Legal Business Name): BRIAN HOWARD SLYWKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

IV. Provider business mailing address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-1105
  • Fax: 805-497-6144
Mailing address:
  • Phone: 805-497-1105
  • Fax: 805-497-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC36499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: