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General NPI Number Information
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NPI Number | 1053656603
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Entity Type | Individual
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Provider Name | JUSTIN BOYE LEVY ASHBY LVN
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Gender | Male
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 1800 GRACE AVE #4
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City | HOLLYWOOD
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State | CA
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Zip | 90028-4201
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Country | US
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Telephone | 323-761-9274
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Fax | 323-380-7709
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Provider Business Mailing Address
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Address Line | 1800 GRACE AVE #4
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City | HOLLYWOOD
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State | CA
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Zip | 90028-4201
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Country | US
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Telephone | 323-761-9274
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Fax | 323-380-7709
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 252854
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License Number State | CA
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