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General NPI Number Information
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NPI Number | 1184846487
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Entity Type | Organization
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Legal Business Name | HUNTINGTON REPRODUCTIVE CENTER
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23961 CALLE DE LA MAGDALENA SUITE 503
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3616
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Country | US
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Telephone | 949-472-9446
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Fax | 949-472-9023
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Provider Business Mailing Address
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Address Line | 23961 CALLE DE LA MAGDALENA SUITE 503
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3616
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Country | US
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Telephone | 949-472-9446
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Fax | 949-472-9023
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DANIEL POTTER
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Credential | MD
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Telephone | 949-472-9446
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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 | 15677
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License Number State | CA
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