Healthcare Provider Details

I. General information

NPI: 1063904530
Provider Name (Legal Business Name): REPRODUCTIVE MEDICINE ASSOCIATES OF NORTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPEAR ST
SAN FRANCISCO CA
94105-1535
US

IV. Provider business mailing address

150 SPEAR ST
SAN FRANCISCO CA
94105-1535
US

V. Phone/Fax

Practice location:
  • Phone: 973-871-1280
  • Fax:
Mailing address:
  • Phone:
  • 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