Healthcare Provider Details

I. General information

NPI: 1336529361
Provider Name (Legal Business Name): REPRODUCTIVE SCIENCES MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 VALLEY CENTRE DR STE 100
SAN DIEGO CA
92130-3340
US

IV. Provider business mailing address

3661 VALLEY CENTRE DR STE 100
SAN DIEGO CA
92130-3340
US

V. Phone/Fax

Practice location:
  • Phone: 858-436-7186
  • Fax: 858-436-7170
Mailing address:
  • Phone: 858-436-7186
  • Fax: 858-436-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLA00011398
License Number StateCA

VIII. Authorized Official

Name: MRS. ELIZABETH M TIPPETTS
Title or Position: BILLING MANAGER
Credential:
Phone: 858-436-7186