Individual
DEBORA IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, PHN, CBIS
Contact information
Practice address
2070 CENTURY PARK E, LOS ANGELES, CA 90067-1907
(714) 887-4997
Mailing address
4402 MAMMOTH AVE APT 5, SHERMAN OAKS, CA 91423-3649
(714) 887-4997
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
562534
CA
163WR0400X
Rehabilitation Registered Nurse
Primary
95260258
CA
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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