Healthcare Provider Details

I. General information

NPI: 1114686862
Provider Name (Legal Business Name): AMERICAN FERTILITY CALIFORNIA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 VALLEY VISTA DR STE 135
DIAMOND BAR CA
91765-3950
US

IV. Provider business mailing address

1370 VALLEY VISTA DR STE 135
DIAMOND BAR CA
91765-3950
US

V. Phone/Fax

Practice location:
  • Phone: 909-777-8888
  • Fax: 909-551-0200
Mailing address:
  • Phone: 97-777-8888
  • Fax: 909-551-0200

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: EVELYN LEW
Title or Position: HR/ADMINISTRATOR
Credential:
Phone: 909-777-8888