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General NPI Number Information
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NPI Number | 1043703622
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CENTRAL COAST IVF LABORATORY
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 35 CASA ST STE 260
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1890
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Country | US
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Telephone | 805-440-7529
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Fax | 805-466-4229
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Provider Business Mailing Address
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Address Line | 35 CASA ST STE 260
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1890
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Country | US
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Telephone | 805-440-7529
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Fax | 805-466-4229
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BARBARA J. CERNY-RYAN
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Credential |
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Telephone | 805-440-7529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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