Healthcare Provider Details

I. General information

NPI: 1194056655
Provider Name (Legal Business Name): LIFOVUM FERTILITY MANAGMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15503 VENTURA BLVD STE 100
ENCINO CA
91436-3114
US

IV. Provider business mailing address

135 S ROASEMEAD BLVD
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-7288
  • Fax:
Mailing address:
  • Phone: 626-204-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOMESH ROY
Title or Position: CEO
Credential:
Phone: 626-204-9699