Ivy Medical Clinic Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A23122 Issued in CA

Legal business name

IVY MEDICAL CLINIC INC

Practice address

705 Ivy St
Glendale, CA 91204

Phone

(818) 945-5523

Fax

(818) 945-5524

NPI assigned

May 8, 2014

Last updated

May 8, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Omar Eduardo Espinosa, M.D.

Title

President/Ceo

Phone

(818) 945-5523

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399507200000",
    "number": "1174934400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 A IVY ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91204",
            "telephone_number": "818-945-5523",
            "fax_number": "818-945-5524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 IVY ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91204",
            "telephone_number": "818-945-5523",
            "fax_number": "818-945-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-08",
        "last_updated": "2014-05-08",
        "status": "A",
        "authorized_official_last_name": "ESPINOSA",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "818-945-5523",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A23122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Iuculano
• Johny IV, MD
• Sunny Ivanyi
• Satenik Ivic, RN
• Ivy Home Health Inc
• Charise Leanne Ivy, M.D.
• Kathryn S Iwata, M.D.
• Sujata Prashant Iyer, M.D.
• Judith Sano Izumi, N.P.
• J Dang Dental (Broadway Dental)

• General Practice Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.