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General NPI Number Information
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NPI Number | 1649255589
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Entity Type | Individual
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Provider Name | DOUGLAS DAVID SLATEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 5046 LADERA VISTA DR
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City | CAMARILLO
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State | CA
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Zip | 93012-5334
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Country | US
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Telephone | 760-390-8030
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Fax | 805-383-2897
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Provider Business Mailing Address
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Address Line | 5046 LADERA VISTA DRIVE
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City | CAMARILLO
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State | CA
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Zip | 93012
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Country | US
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Telephone | 760-390-8030
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Fax | 805-383-2897
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G59150
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License Number State | CA
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