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General NPI Number Information
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NPI Number | 1003004169
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Entity Type | Individual
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Provider Name | SUSAN LEE IVEY MD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 2140 SHATTUCK AVE 10TH FLOOR, HEALTH RESEARCH FOR ACTION, UC-BERKELEY SPH
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City | BERKELEY
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State | CA
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Zip | 94704-1210
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Country | US
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Telephone | 510-643-1883
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Fax | 510-643-7976
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Provider Business Mailing Address
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Address Line | 131 EMERALD DR
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City | DANVILLE
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State | CA
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Zip | 94526-2426
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Country | US
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Telephone | 925-362-8227
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Fax | 925-362-8228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C43335
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License Number State | CA
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