Healthcare Provider Details

I. General information

NPI: 1093891152
Provider Name (Legal Business Name): SAN DIEGO CENTER FOR REPRODUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST PLAZA LEVEL
SAN DIEGO CA
92123-2778
US

IV. Provider business mailing address

8010 FROST ST PLAZA LEVEL
SAN DIEGO CA
92123-2778
US

V. Phone/Fax

Practice location:
  • Phone: 858-505-5500
  • Fax: 858-505-5555
Mailing address:
  • Phone: 858-505-5500
  • Fax: 858-505-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA48365
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON KINNEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 858-505-5500