Organization
IVY MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR EDUARDO ESPINOSA M.D. (PRESIDENT/CEO)
(818) 945-5523
Entity
Organization
Contact information
Practice address
705 IVY ST, GLENDALE, CA 91204
(818) 945-5523
(818) 945-5524
Mailing address
705 A IVY ST, GLENDALE, CA 91204
(818) 945-5523
(818) 945-5524
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A23122
CA
Other
Enumeration date
05/08/2014
Last updated
05/08/2014
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