Ivy Medical Clinic Inc

NPI 1174934400 - General Practice - 208D00000X

NPI Details
NPI 1174934400
Enumeration Date 05/08/2014
Last Updated 05/08/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name OMAR EDUARDO OMAR
Position PRESIDENT/CEO
Phone (818) 945-5523
Fax (818) 945-5524
Practice Location
705 IVY ST
GLENDALE CA, 91204, US
Phone (818) 945-5523
Fax (818) 945-5524
Business Location
705 A IVY ST
GLENDALE CA, 91204, US
Phone (818) 945-5523
Fax (818) 945-5524
Toxanomy
Taxonomy Code 208D00000X
License State California
License Number A23122
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According to our database, Ivy Medical Clinic Inc NPI is 1174934400, taxonomy code is 208D00000X and license number is A23122, license state is located at California. Ivy Medical Clinic Inc physically located at 705 Ivy St, Glendale CA, 91204. NPI Number 1033115704 has the healthcare provider type.

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1174934400 NPI number is provided on an as is basis without warranty of any kind. 1174934400 is maintained by the National Plan & Provider Enumeration System. The contents of Ivy Medical Clinic Inc are for informational purposes only.