Healthcare Provider Details

I. General information

NPI: 1740125939
Provider Name (Legal Business Name): IVANA MAURIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E ACACIA AVE
GLENDALE CA
91205-2823
US

IV. Provider business mailing address

2026 LILAC LN
GLENDALE CA
91206-2916
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-2421
  • Fax:
Mailing address:
  • Phone: 818-935-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: