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General NPI Number Information
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NPI Number | 1124670674
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Entity Type | Organization
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Legal Business Name | EDEN FERTILITY CENTER OF NEWPORT BEACH
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 20360 SW BIRCH ST STE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1534
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Country | US
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Telephone | 949-688-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 20360 SW BIRCH ST STE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1534
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Country | US
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Telephone | 949-688-1002
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MICHAEL RUSZCZYNSKI
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Credential |
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Telephone | 310-927-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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