| Ivy Medical Clinic Inc | |
|
705 Ivy St Glendale CA 91204 | |
| (818) 945-5523 | |
| (818) 945-5524 |
| Full Name | Ivy Medical Clinic Inc |
|---|---|
| Speciality | General Practice |
| Location | 705 Ivy St, Glendale, California |
| Authorized Official Name and Position | Omar Eduardo Espinosa (PRESIDENT/CEO) |
| Authorized Official Contact | 8189455523 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Medical Clinic Inc 705 A Ivy St Glendale CA 91204 Ph: (818) 945-5523 | Ivy Medical Clinic Inc 705 Ivy St Glendale CA 91204 Ph: (818) 945-5523 |
| NPI Number | 1174934400 |
|---|---|
| Provider Enumeration Date | 05/08/2014 |
| Last Update Date | 05/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174934400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A23122 (California) | Primary |
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