NPIMap

Organization Active NPI

Ivancich Podiatry Services, Inc.

  • Podiatrist
  • El Monte, CA
National Provider Identifier
1306015086
Registry record updated Sep 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E3249 Issued in CA
Legal business name
IVANCICH PODIATRY SERVICES, INC.
Practice address
11800 Valley Blvd
El Monte, CA 91732-3040
Phone
(626) 401-2775
Fax
(626) 401-9826
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

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

Authorized official

Name
Larry M. Ivancich, D.P.M.NPI 1912905472
Title
Podiatrist
Phone
(626) 401-2775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E3249 CA Primary

Addresses

Primary practice location

11800 Valley Blvd
El Monte, CA 91732-3040

Mailing address

PO Box 660025
Arcadia, CA 91066-0025
Phone (626) 401-2775

Other names 1

  • Larry M. Ivancich Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1306015086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660025",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910660025",
            "telephone_number": "626-401-2775",
            "fax_number": "626-401-9826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 VALLEY BLVD",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917323040",
            "telephone_number": "626-401-2775",
            "fax_number": "626-401-9826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVANCICH PODIATRY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "IVANCICH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "626-401-2775",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E3249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Larry M. Ivancich",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in El Monte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.