Healthcare Provider Details

I. General information

NPI: 1447289335
Provider Name (Legal Business Name): FERTILITY AND SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ROLLING OAKES DRIVE #110 FERTILITY AND SURGICAL ASSOCIATES
THOUSAND OAKS CA
91361
US

IV. Provider business mailing address

325 ROLLING OAKES DRIVE #110 FERTILITY AND SURGICAL ASSOCIATES
THOUSAND OAKS CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-778-1122
  • Fax: 805-778-0610
Mailing address:
  • Phone: 805-778-1122
  • Fax: 805-778-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG060146
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA80341
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG055771
License Number StateCA

VIII. Authorized Official

Name: GARY DAVID HUBERT
Title or Position: PHYSICIAN
Credential: MD
Phone: 805-778-1122