Provider Demographics
NPI:1093495541
Name:CAPARROSO, IVY OLIVEROS (NP)
Entity Type:Individual
Prefix:MRS
First Name:IVY
Middle Name:OLIVEROS
Last Name:CAPARROSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 CONQUISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3204
Mailing Address - Country:US
Mailing Address - Phone:310-938-8737
Mailing Address - Fax:
Practice Address - Street 1:4222 CONQUISTA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3204
Practice Address - Country:US
Practice Address - Phone:310-938-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty