Healthcare Provider Details

I. General information

NPI: 1538319066
Provider Name (Legal Business Name): REPROGENETICS CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W. OLYMPIC BLVD SUITE 360
LOS ANGELES CA
90064
US

IV. Provider business mailing address

75 CORPORATE DRIVE
TRUMBULL CT
06611-1350
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-0427
  • Fax:
Mailing address:
  • Phone: 203-601-5200
  • Fax: 973-992-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number099499
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN TUCKER
Title or Position: CFO
Credential:
Phone: 203-601-9808