Healthcare Provider Details

I. General information

NPI: 1063919512
Provider Name (Legal Business Name): OHIO FERTILITY PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS ROAD SUITE 455
CINCINNATI OH
45209
US

IV. Provider business mailing address

15821 VENTURA BLVD, SUITE 625
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-858-1080
  • Fax: 513-924-5551
Mailing address:
  • Phone: 513-924-5550
  • Fax: 513-924-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: GOLDIE GUPTA
Title or Position: CFO
Credential:
Phone: 630-536-7738