Healthcare Provider Details

I. General information

NPI: 1033394598
Provider Name (Legal Business Name): LIFOVUM FERTILITY MANAGMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S ARROYO PKWY
PASADENA CA
91105-2515
US

IV. Provider business mailing address

135 S ROSEMEAD BLVD
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-9161
  • Fax: 626-440-0138
Mailing address:
  • Phone: 626-204-9699
  • Fax: 626-440-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOMESH ROY
Title or Position: CEO
Credential:
Phone: 626-204-9699