MEDICARE: LIFOVUM FERTILITY MANAGMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1093046559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFOVUM FERTILITY MANAGMENT, LLC

Provider Business Mailing Address
First Line	:	135 S ROSEMEAD BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107
Country	:	US
Telephone Number	:	626-204-9699
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SUPERIOR AVE STE 130
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3659
Country	:	US
Telephone Number	:	626-440-9161
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SOMESH ROY
Credential	:
Telephone Number	:	626-204-9699

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	10/27/2017

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