Provider Demographics
NPI:1982220588
Name:SLOUGH, ELMA M
Entity Type:Individual
Prefix:
First Name:ELMA
Middle Name:M
Last Name:SLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELMA
Other - Middle Name:
Other - Last Name:TULOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35589 VELARDO DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4921
Mailing Address - Country:US
Mailing Address - Phone:909-797-5147
Mailing Address - Fax:
Practice Address - Street 1:461 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8167
Practice Address - Country:US
Practice Address - Phone:909-475-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013821363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health