Healthcare Provider Details

I. General information

NPI: 1609791789
Provider Name (Legal Business Name): LA UROGYNECOLOGY & ENDOMETRIOSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 GLENCOE AVE STE C9-9731
MARINA DEL REY CA
90292-9991
US

IV. Provider business mailing address

4325 GLENCOE AVE STE C9-9731
MARINA DEL REY CA
90292-9991
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-3212
  • Fax: 949-502-8887
Mailing address:
  • Phone: 310-869-3212
  • Fax: 949-502-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOORENA FATEHCHEHR
Title or Position: CEO
Credential: MD
Phone: 310-869-3212