Healthcare Provider Details

I. General information

NPI: 1013836436
Provider Name (Legal Business Name): SOUTH COAST FERTILITY LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

IV. Provider business mailing address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

V. Phone/Fax

Practice location:
  • Phone: 949-848-4500
  • Fax: 949-848-4501
Mailing address:
  • Phone: 949-848-4500
  • Fax: 949-848-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENE ROYSTER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 949-848-4500