MEDICARE: INFERTILITY LABORATORIES OF LAS VEGAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	2173REG-12	NV
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1477919082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFERTILITY LABORATORIES OF LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	15821 VENTURA BLVD, SUITE 625
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436
Country	:	US
Telephone Number	:	818-858-1082
Fax Number	:

Provider Business Practice Location Address
First Line	:	8851 WEST SAHARA AVE, SUITE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117
Country	:	US
Telephone Number	:	818-858-1080
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	GOLDIE GUPTA
Credential	:
Telephone Number	:	630-536-7738

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	09/13/2021

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