Healthcare Provider Details

I. General information

NPI: 1689106908
Provider Name (Legal Business Name): BAY AREA CENTER FOR REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 MARSH RD FL 1
MENLO PARK CA
94025-1020
US

IV. Provider business mailing address

405 EL CAMINO REAL # 336
MENLO PARK CA
94025-5240
US

V. Phone/Fax

Practice location:
  • Phone: 650-646-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SALLI TAZUKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-391-5473