Individual
DR. LARRY IVANCICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11800 VALLEY BLVD, EL MONTE, CA 91732-3040
(626) 401-2775
(626) 401-9826
Mailing address
PO BOX 660025, ARCADIA, CA 91066-0025
(626) 401-2775
(626) 401-9826
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E3249
CA
Other
Enumeration date
07/08/2005
Last updated
02/25/2008
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