Basic Information
| Provider Information | |||||||||
| NPI: | 1407244767 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFIC FERTILITY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10921 WILSHIRE BLVD STE 700 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900244003 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10921 WILSHIRE BLVD STE 700 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900244003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102097700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2015 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | OUNDJIAN | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8185047265 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0006X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Fertility Facility |
No ID Information.