Healthcare Provider Details

I. General information

NPI: 1528351327
Provider Name (Legal Business Name): ASSISTED REPRODUCTION LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 SANTA MONICA BLVD SUITE 100A
SANTA MONICA CA
90404-2429
US

IV. Provider business mailing address

2825 SANTA MONICA BLVD SUITE 100A
SANTA MONICA CA
90404-2429
US

V. Phone/Fax

Practice location:
  • Phone: 310-566-1470
  • Fax: 310-566-1485
Mailing address:
  • Phone: 310-566-1470
  • Fax: 310-566-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN KUMAR JAIN
Title or Position: MANAGER
Credential: MD
Phone: 310-566-1470