Individual
GINGER C SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 460, LOS ANGELES, CA 90095-5224
(310) 825-5510
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
137108
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
04/12/2013
Last updated
10/12/2020
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