Healthcare Provider Details

I. General information

NPI: 1164853305
Provider Name (Legal Business Name): REPRODUCTIVE SPECIALTY SURGERICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

15500 SAND CANYON AVE SUITE 100
IRVINE CA
92618-7709
US

IV. Provider business mailing address

15500 SAND CANYON AVE SUITE 100
IRVINE CA
92618-7709
US

V. Phone/Fax

Practice location:
  • Phone: 949-726-0600
  • Fax: 949-726-0601
Mailing address:
  • Phone: 949-726-0600
  • Fax: 949-726-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number4567
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE B WERLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-726-0648