Provider Demographics
NPI:1851856751
Name:SLATER, STUART DONALD
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:DONALD
Last Name:SLATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E ORANGETHORPE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5205
Mailing Address - Country:US
Mailing Address - Phone:714-254-8473
Mailing Address - Fax:
Practice Address - Street 1:1501 E ORANGETHORPE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5205
Practice Address - Country:US
Practice Address - Phone:714-254-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker