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General NPI Number Information
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NPI Number | 1053680306
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Entity Type | Organization
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Legal Business Name | PACIFIC REPRODUCTIVE SERVICES, INC.
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 65 N MADISON AVE SUITE 610
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone | 626-432-1681
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Fax |
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Provider Business Mailing Address
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Address Line | 65 N MADISON AVE SUITE 610
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TISSUE BANK DIRECTOR
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Name | STACEY L POSTON
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Credential | RN, MSN, FNP
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Telephone | 626-432-1681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 574386
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 470207
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License Number State | CA
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