Provider Demographics
NPI:1730291675
Name:SLAVIN, STUART (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:SLAVIN
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 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-828-7172
Mailing Address - Fax:310-394-7807
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#265
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90074
Practice Address - Country:US
Practice Address - Phone:310-206-6923
Practice Address - Fax:310-394-7807
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54766207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547660Medicaid
CAWG54766BMedicare PIN
CA00G547660Medicaid