Healthcare Provider Details

I. General information

NPI: 1316162399
Provider Name (Legal Business Name): FERTILITY CENTER OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 BARRANCA PARKWAY, SUITE 200
IRVINE CA
92604
US

IV. Provider business mailing address

4980 BARRANCA PARKWAY, SUITE 200
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-0072
  • Fax: 949-955-0077
Mailing address:
  • Phone: 949-955-0072
  • Fax: 949-955-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG071146
License Number StateCA

VIII. Authorized Official

Name: LLENE E HATCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-955-0072