| NPI | 1306015086 |
|---|---|
| Former Legal Business Name | LARRY M. IVANCICH |
| Entity Type | Organization |
| Authorized Contact | LARRY M. IVANCICH Podiatrist 626-401-2775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3249) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-09-11 |