Individual
DR. CHARISE LEANNE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 E CHEVY CHASE DR STE 401, GLENDALE ADVENTIST MEDICAL CENTER SPINE INSTITUTE, GLENDALE, CA 91206-4153
(818) 863-4451
(818) 863-4984
Mailing address
PO BOX 1237, SIERRA MADRE, CA 91025-4237
(626) 808-5352
(626) 797-3864
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
242320
MA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A86275
CA
Other
Enumeration date
11/21/2006
Last updated
05/19/2016
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