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General NPI Number Information
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NPI Number | 1003545641
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Entity Type | Individual
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Provider Name | IVY H VU
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 74333 CA-111 STE 204
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-507-5921
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 POINSETTIA CIR
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City | CALIMESA
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State | CA
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Zip | 92320-4918
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Country | US
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Telephone | 760-507-5921
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F09221297
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License Number State | CA
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