Provider Demographics
NPI:1407903354
Name:SLYWKA, BRIAN HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:HOWARD
Last Name:SLYWKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1275
Mailing Address - Country:US
Mailing Address - Phone:805-497-1105
Mailing Address - Fax:805-497-6144
Practice Address - Street 1:351 ROLLING OAKS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1275
Practice Address - Country:US
Practice Address - Phone:805-497-1105
Practice Address - Fax:805-497-6144
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36499208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36499OtherLICENSE
CAC36499OtherLICENSE
CAC36499OtherLICENSE
AS6516895OtherDEA