Provider Demographics
NPI:1780959155
Name:JORIF, IVONNE T
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:T
Last Name:JORIF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 KALSMAN DR
Mailing Address - Street 2:#3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4416
Mailing Address - Country:US
Mailing Address - Phone:310-559-9426
Mailing Address - Fax:
Practice Address - Street 1:3632 KALSMAN DR
Practice Address - Street 2:#3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4416
Practice Address - Country:US
Practice Address - Phone:310-559-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical