MEDICARE: COMPREHENSIVE HEALTH FOR ALL FERTILITY MEDICAL GROUP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1215100433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE HEALTH FOR ALL FERTILITY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	1904
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-525-3377
Fax Number	:	323-525-3376

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	1904
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-525-3377
Fax Number	:	323-525-3376

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. MARJORIE LYNN DIMASHKIE
Credential	:
Telephone Number	:	323-525-3377

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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