Provider Demographics
NPI:1679874861
Name:IRVINE, FLORENCE C (MD)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:C
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 204
Mailing Address - Street 2:15525 ELK MOUNTAIN ROAD
Mailing Address - City:UPPER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95485
Mailing Address - Country:US
Mailing Address - Phone:707-275-0903
Mailing Address - Fax:
Practice Address - Street 1:15525 ELK MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485
Practice Address - Country:US
Practice Address - Phone:707-275-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG113352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry