Provider Demographics
NPI:1053656603
Name:ASHBY, JUSTIN BOYE LEVY (LVN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:BOYE LEVY
Last Name:ASHBY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GRACE AVE
Mailing Address - Street 2:#4
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4201
Mailing Address - Country:US
Mailing Address - Phone:323-761-9274
Mailing Address - Fax:323-380-7709
Practice Address - Street 1:1800 GRACE AVE
Practice Address - Street 2:#4
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-4201
Practice Address - Country:US
Practice Address - Phone:323-761-9274
Practice Address - Fax:323-380-7709
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252854164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse