Individual
MISS IVY L KASALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., MSN
Contact information
Practice address
1401 S GRAND AVE, LOS ANGELES, CA 90015-3010
(213) 748-2411
Mailing address
2207 N WESTERN AVE APT 3A, CHICAGO, IL 60647-4568
(607) 327-3326
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
669720
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000114
CA
Other
Enumeration date
09/12/2011
Last updated
11/12/2018
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