Provider Demographics
NPI:1851693436
Name:IVY, OLIVIA (MD MPH AAHIVS)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:MD MPH AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:2927 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3721
Practice Address - Country:US
Practice Address - Phone:512-640-3100
Practice Address - Fax:833-687-1671
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197947207R00000X
TXS63862083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS6386OtherTEXAS MEDICAL LICENSE
LA322610OtherLOUISIANA MEDICAL LICENSE
PAMT197947OtherPA TRAINING LICENSE