Provider Demographics
NPI:1063126829
Name:IVERS, MARIFEL ANTONETTE
Entity type:Individual
Prefix:
First Name:MARIFEL
Middle Name:ANTONETTE
Last Name:IVERS
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 1:20181 CROWN REEF LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4515
Mailing Address - Country:US
Mailing Address - Phone:562-644-0603
Mailing Address - Fax:714-369-2780
Practice Address - Street 1:20181 CROWN REEF LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4515
Practice Address - Country:US
Practice Address - Phone:562-644-0603
Practice Address - Fax:714-369-2780
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004786372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion