Healthcare Provider Details

I. General information

NPI: 1497215727
Provider Name (Legal Business Name): MARGARITA IVANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA182887
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA182887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: