Provider Demographics
NPI:1043205909
Name:SLAVOV, CARMEN S (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:S
Last Name:SLAVOV
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8510 BALBOA BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3583
Mailing Address - Country:US
Mailing Address - Phone:818-810-4636
Mailing Address - Fax:818-654-3417
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:STE 200
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-254-1500
Practice Address - Fax:818-244-4830
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2014-04-28
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Provider Licenses
StateLicense IDTaxonomies
CAC53065207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C530650Medicaid
NJH29597Medicare UPIN