Healthcare Provider Details

I. General information

NPI: 1265599088
Provider Name (Legal Business Name): LA JOLLA IVF,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE, SUITE 610
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

9850 GENESEE AVE, SUITE 610
LA JOLLA CA
92037-1224
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-2221
  • Fax: 858-558-2263
Mailing address:
  • Phone: 858-558-2221
  • Fax: 858-558-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID B SMOTRICH
Title or Position: FOUNDER AND MEDICAL DIRECTOR
Credential: M.D.
Phone: 858-558-2221