Healthcare Provider Details

I. General information

NPI: 1417860669
Provider Name (Legal Business Name): IVAN SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11627 BROOKSHIRE AVE
DOWNEY CA
90241-4911
US

IV. Provider business mailing address

1269 N WILMINGTON BLVD
WILMINGTON CA
90744-2454
US

V. Phone/Fax

Practice location:
  • Phone: 562-469-6500
  • Fax:
Mailing address:
  • Phone: 661-333-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: