Healthcare Provider Details

I. General information

NPI: 1821422106
Provider Name (Legal Business Name): REPRODUCTIVE GENETICS AND FERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S 19TH ST
TACOMA WA
98405-2962
US

IV. Provider business mailing address

PO BOX 8550
TACOMA WA
98419-0550
US

V. Phone/Fax

Practice location:
  • Phone: 253-777-1964
  • Fax: 253-473-6715
Mailing address:
  • Phone: 253-777-1964
  • Fax: 253-473-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN A SORENSEN
Title or Position: ADMIN
Credential:
Phone: 602-431-1152