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General NPI Number Information
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NPI Number | 1811970015
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Entity Type | Individual
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Provider Name | PETER D. SLISKOVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 01/16/2022
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Provider Practice Location Address
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Address Line | 1360 W 6TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-833-2461
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Fax | 310-833-6342
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Provider Business Mailing Address
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Address Line | 1600 S GAFFEY ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-4628
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Country | US
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Telephone | 310-548-0201
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Fax | 310-547-3340
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A133295
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License Number State | CA
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