Provider Demographics
NPI:1023768033
Name:SLADICS, SELINA DANIELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:SELINA
Middle Name:DANIELLE
Last Name:SLADICS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SELINA
Other - Middle Name:DANIELLE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:845 W LA VETA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3930
Mailing Address - Country:US
Mailing Address - Phone:714-639-2600
Mailing Address - Fax:
Practice Address - Street 1:845 W LA VETA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-639-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018986363LA2100X, 363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology