Provider Demographics
NPI:1386873776
Name:SLATER, SANDRA V (PSYD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:V
Last Name:SLATER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:PATRICIA
Other - Last Name:VARGAS DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2331 POPPY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2177
Mailing Address - Country:US
Mailing Address - Phone:424-345-5644
Mailing Address - Fax:
Practice Address - Street 1:2331 POPPY HILLS DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2177
Practice Address - Country:US
Practice Address - Phone:424-345-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY30883OtherCALIFORNIA BOARD OF PSYCHOLOGY, PSYCHOLOGY LICENSE