Healthcare Provider Details

I. General information

NPI: 1326665621
Provider Name (Legal Business Name): REPRODUCTIVE MEDICINE ASSOCIATES OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 150
SAN DIEGO CA
92121-2155
US

IV. Provider business mailing address

140 ALLEN RD
BASKING RIDGE NJ
07920-2976
US

V. Phone/Fax

Practice location:
  • Phone: 908-604-7800
  • Fax:
Mailing address:
  • Phone: 908-604-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA JENCO
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 973-656-2840