Provider Demographics
NPI:1891864021
Name:SLOMINSKI, SUSAN DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:SLOMINSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 S 8TH AVE
Mailing Address - Street 2:#A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-344-5771
Mailing Address - Fax:928-344-6064
Practice Address - Street 1:2741 S 8TH AVE
Practice Address - Street 2:#A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-5771
Practice Address - Fax:928-344-6064
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2848207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ316879Medicaid
CAXPY184926Medicaid
CAXPY184926Medicaid
AZ316879Medicaid