Healthcare Provider Details

I. General information

NPI: 1033546916
Provider Name (Legal Business Name): REPRODUCTIVE PARTNERS MEDICAL GROUP LA JOLLA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 800
LA JOLLA CA
92037-1219
US

IV. Provider business mailing address

9850 GENESEE AVE STE 800
LA JOLLA CA
92037-1219
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-9177
  • Fax: 858-552-9188
Mailing address:
  • Phone: 858-552-9177
  • Fax: 858-552-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA43141
License Number StateCA

VIII. Authorized Official

Name: VICENTE GABRIEL GARZO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 858-552-9177