Healthcare Provider Details

I. General information

NPI: 1184638488
Provider Name (Legal Business Name): IVY L DARDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE DEPT OF MEDICINE (111)
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVE DEPT OF MEDICINE (111)
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-5327
  • Fax: 559-241-6484
Mailing address:
  • Phone: 559-228-5327
  • Fax: 559-241-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG55952
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG55952
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG55952
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG55952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: