Individual
IVY GRACE BAS DUENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11080 W OLYMPIC BLVD, LOS ANGELES, CA 90064-1937
(310) 966-6600
Mailing address
11080 W OLYMPIC BLVD, LOS ANGLES, CA 90064
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
07/19/2017
Last updated
06/08/2023
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