Provider Demographics
NPI:1831549724
Name:IVY JOEVA
Entity type:Organization
Organization Name:IVY JOEVA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-634-8192
Mailing Address - Street 1:1518 19TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3437
Mailing Address - Country:US
Mailing Address - Phone:310-634-8192
Mailing Address - Fax:
Practice Address - Street 1:1518 19TH ST APT C
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3437
Practice Address - Country:US
Practice Address - Phone:310-634-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty