Healthcare Provider Details

I. General information

NPI: 1053680306
Provider Name (Legal Business Name): PACIFIC REPRODUCTIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE SUITE 610
PASADENA CA
91101-2035
US

IV. Provider business mailing address

65 N MADISON AVE SUITE 610
PASADENA CA
91101-2035
US

V. Phone/Fax

Practice location:
  • Phone: 626-432-1681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number574386
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number470207
License Number StateCA

VIII. Authorized Official

Name: STACEY L POSTON
Title or Position: TISSUE BANK DIRECTOR
Credential: RN, MSN, FNP
Phone: 626-432-1681