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General NPI Number Information
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NPI Number | 1396961082
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Entity Type | Organization
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Legal Business Name | LA IVF LAB LLC.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 250 N ROBERTSON BLVD #403
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1788
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Country | US
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Telephone | 310-888-8874
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Fax | 310-285-0334
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Provider Business Mailing Address
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Address Line | 250 N ROBERTSON BLVD #403
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1788
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Country | US
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Telephone | 310-888-8874
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Fax | 310-285-0334
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL M KAMRAVA
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Credential | MD
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Telephone | 310-888-8874
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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 | CLF11205
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License Number State | CA
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