Healthcare Provider Details

I. General information

NPI: 1457791485
Provider Name (Legal Business Name): ELITE FERTILITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 207
CHINO CA
91710-1401
US

IV. Provider business mailing address

13768 ROSWELL AVE SUITE 207
CHINO CA
91710-1401
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-2229
  • Fax: 909-628-7822
Mailing address:
  • Phone: 909-591-2229
  • Fax: 909-628-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG85448
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG85448
License Number StateCA

VIII. Authorized Official

Name: DR. ROSELYN MATEO DINSAY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 909-591-2229