Provider Demographics
NPI:1962824524
Name:MALATI, IVY (DC)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:MALATI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:
Other - Last Name:KHACHATOURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:18734 VISTA DEL CANON UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-4528
Mailing Address - Country:US
Mailing Address - Phone:818-913-7758
Mailing Address - Fax:
Practice Address - Street 1:1107 S ALVARADO ST STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4161
Practice Address - Country:US
Practice Address - Phone:323-895-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor