Provider Demographics
NPI:1972356434
Name:EGIEBOR, IVIE CLEOPATRA (MD, DRPH, MPH)
Entity Type:Individual
Prefix:DR
First Name:IVIE
Middle Name:CLEOPATRA
Last Name:EGIEBOR
Suffix:
Gender:F
Credentials:MD, DRPH, MPH
Other - Prefix:DR
Other - First Name:QUEEN-IVIE
Other - Middle Name:CLEOPATRA
Other - Last Name:EGIEBOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLAZA, INTERNAL MEDICINE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7419
Mailing Address - Country:US
Mailing Address - Phone:310-825-7375
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA, INTERNAL MEDICINE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7419
Practice Address - Country:US
Practice Address - Phone:310-825-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program