Basic Information
| Provider Information | |||||||||
| NPI: | 1255354783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLATE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | KENDRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1607 | ||||||||
| Address2: | |||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902721607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513033391 | ||||||||
| FaxNumber: | 9513463627 | ||||||||
| Practice Location | |||||||||
| Address1: | 8700 BEVERLY BLVD | ||||||||
| Address2: | CS-OCC | ||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900481804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104231155 | ||||||||
| FaxNumber: | 3106593928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | G44344 | CA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.