Healthcare Provider Details

I. General information

NPI: 1548541287
Provider Name (Legal Business Name): MR. BRUCE ALAN IVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

IV. Provider business mailing address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-8090
  • Fax: 916-974-7851
Mailing address:
  • Phone: 916-974-8090
  • Fax: 916-974-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: