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General NPI Number Information
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NPI Number | 1225631484
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Entity Type | Organization
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Legal Business Name | FERTILITY LAB SCIENCES OF ORANGE COUNTY, LLC
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 3501 JAMBOREE RD STE 450
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2916
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Country | US
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Telephone | 949-531-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 9380 STATION ST
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City | LONE TREE
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State | CO
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Zip | 80124-6831
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Country | US
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Telephone | 860-303-8855
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICE
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Name | JON PARDEW
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Credential |
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Telephone | 303-968-1950
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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 |
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