Healthcare Provider Details

I. General information

NPI: 1235646985
Provider Name (Legal Business Name): LOS ANGELES REPRODUCTIVE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 1127
ENCINO CA
91436-2612
US

IV. Provider business mailing address

16055 VENTURA BLVD STE 1127
ENCINO CA
91436-2612
US

V. Phone/Fax

Practice location:
  • Phone: 818-946-8051
  • Fax: 818-946-8052
Mailing address:
  • Phone: 818-946-8051
  • Fax: 818-946-8052

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: HELENA LIVINGSTON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 818-946-8051