Healthcare Provider Details

I. General information

NPI: 1679080923
Provider Name (Legal Business Name): REPRODUCTIVE MEDICINE ASSOCIATES OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W. ALAMEDA AVENUE SUITE 404
BURBANK CA
91505
US

IV. Provider business mailing address

140 ALLEN ROAD
BASKING RIDGE NJ
07920
US

V. Phone/Fax

Practice location:
  • Phone: 866-762-3140
  • Fax: 424-293-8138
Mailing address:
  • Phone: 866-762-3140
  • Fax: 973-290-8370

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: REBECCA JENCO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 973-656-2840