MEDICARE: DR. SANDRA V. SLATER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY30883	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY30883	OTHER	CA	CALIFORNIA BOARD OF PSYCHOLOGY, PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1386873776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA V. SLATER PSYD

Provider Business Mailing Address
First Line	:	2331 POPPY HILLS DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2177
Country	:	US
Telephone Number	:	424-345-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 POPPY HILLS DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2177
Country	:	US
Telephone Number	:	424-345-5644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	08/22/2022

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