MEDICARE: IVY MALATI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	32348	CA

General Provider Information

NPI Number	:	1962824524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY MALATI DC

Provider Business Mailing Address
First Line	:	18734 VISTA DEL CANON UNIT C
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-4528
Country	:	US
Telephone Number	:	818-913-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S ALVARADO ST STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-4161
Country	:	US
Telephone Number	:	323-895-2711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	03/26/2020

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