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NPI Code Detail

MEDICARE: STEVEN MATHEW SLATTEN M.ED

MEDICARE: STEVEN MATHEW SLATTEN M.ED
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1780431379
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN MATHEW SLATTEN M.ED
Provider Business Mailing Address
First Line : 5555 RESERVOIR DR STE 108
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5136
Country : US
Telephone Number : 619-363-4247
Fax Number :
Provider Business Practice Location Address
First Line : 5555 RESERVOIR DR STE 108
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5136
Country : US
Telephone Number : 619-362-4247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2024
Last Update Date : 05/02/2024

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