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General NPI Number Information
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NPI Number | 1285223271
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Entity Type | Individual
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Provider Name | STEPHANIE TRUONG SLAGEL OD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 849 S SHENANDOAH ST APT 110
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City | LOS ANGELES
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State | CA
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Zip | 90035-1769
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Country | US
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Telephone | 316-312-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 849 S SHENANDOAH ST APT 110
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City | LOS ANGELES
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State | CA
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Zip | 90035-1769
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Country | US
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Telephone | 316-312-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT34753
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License Number State | CA
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