Provider Demographics
NPI:1578606521
Name:SLOVER, KRISTAL ELIZABETH-EMIG
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:ELIZABETH-EMIG
Last Name:SLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CALLE TIO
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5424
Mailing Address - Country:US
Mailing Address - Phone:805-931-0566
Mailing Address - Fax:
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407-0388
Practice Address - Country:US
Practice Address - Phone:805-756-6065
Practice Address - Fax:805-756-7058
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578606521OtherNPI