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General NPI Number Information
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NPI Number | 1093891152
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Entity Type | Organization
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Legal Business Name | SAN DIEGO CENTER FOR REPRODUCTIVE SURGERY
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 8010 FROST ST PLAZA LEVEL
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City | SAN DIEGO
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State | CA
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Zip | 92123-2778
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Country | US
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Telephone | 858-505-5500
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Fax | 858-505-5555
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Provider Business Mailing Address
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Address Line | 8010 FROST ST PLAZA LEVEL
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City | SAN DIEGO
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State | CA
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Zip | 92123-2778
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Country | US
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Telephone | 858-505-5500
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Fax | 858-505-5555
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | SHARON KINNEY
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Credential |
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Telephone | 858-505-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | A48365
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QA0006X
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Taxonomy Name | Ambulatory Fertility Facility
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License Number |
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License Number State |
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