Healthcare Provider Details

I. General information

NPI: 1245249853
Provider Name (Legal Business Name): LAUREL FERTILITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA ST SUITE 570
SAN FRANCISCO CA
94109-4586
US

IV. Provider business mailing address

1700 CALIFORNIA ST SUITE 570
SAN FRANCISCO CA
94109-4586
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-9199
  • Fax: 415-673-8796
Mailing address:
  • Phone: 415-673-9199
  • Fax: 415-673-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG79169
License Number StateCA

VIII. Authorized Official

Name: DR. COLLIN B SMIKLE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-673-9199