Healthcare Provider Details

I. General information

NPI: 1932970449
Provider Name (Legal Business Name): COLLAB FERTILITY MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 YGNACIO VALLEY RD STE 170
WALNUT CREEK CA
94598-3460
US

IV. Provider business mailing address

2700 YGNACIO VALLEY RD STE 170
WALNUT CREEK CA
94598-3460
US

V. Phone/Fax

Practice location:
  • Phone: 925-270-2992
  • Fax: 925-588-7980
Mailing address:
  • Phone: 925-270-2992
  • Fax: 925-588-7980

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: THALIA RUTH SEGAL
Title or Position: OWNER
Credential: MD
Phone: 925-270-2992