Provider Demographics
NPI:1386045615
Name:MADELINE L SLATER MD INC
Entity Type:Organization
Organization Name:MADELINE L SLATER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-806-9263
Mailing Address - Street 1:122 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6040
Mailing Address - Country:US
Mailing Address - Phone:760-806-9263
Mailing Address - Fax:760-806-9264
Practice Address - Street 1:122 CIVIC CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6040
Practice Address - Country:US
Practice Address - Phone:760-806-9263
Practice Address - Fax:760-806-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty