Provider Demographics
NPI:1538225123
Name:SLOSAR, JOHN (JAY) RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN (JAY)
Middle Name:RICHARD
Last Name:SLOSAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CORPORATE PARK STE 235
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5157
Mailing Address - Country:US
Mailing Address - Phone:949-851-8277
Mailing Address - Fax:949-852-0220
Practice Address - Street 1:7 CORPORATE PARK STE 235
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5157
Practice Address - Country:US
Practice Address - Phone:949-851-8277
Practice Address - Fax:949-852-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist