Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-12-12648 | CA |
Y | 111NN0400X | Neurology | DC22169 | CA |
NPI | 1346464690 |
---|---|
Provider Name | Michael J Slone |
First Address | Fremont, CA 94536-5757 |
Second Address | Fremont, CA 94536-5757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U40288 | (02) | CA |