1578606521 NPI number — MRS. KRISTAL ELIZABETH-EMIG SLOVER

Table of content: MRS. KRISTAL ELIZABETH-EMIG SLOVER (NPI 1578606521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578606521 NPI number — MRS. KRISTAL ELIZABETH-EMIG SLOVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOVER
Provider First Name:
KRISTAL
Provider Middle Name:
ELIZABETH-EMIG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578606521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 CALLE TIO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIPOMO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93444-5424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-931-0566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93407-0388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-756-6065
Provider Business Practice Location Address Fax Number:
805-756-7058
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1578606521 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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