MEDICARE: PACIFIC FERTILITY CENTER

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	261QA0006X	Ambulatory Fertility Facility

General Provider Information

NPI Number	:	1407244767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC FERTILITY CENTER

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD STE 700
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD STE 700
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4003
Country	:	US
Telephone Number	:	310-209-7700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARY OUNDJIAN
Credential	:
Telephone Number	:	818-504-7265

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	01/08/2015

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Directions to “PACIFIC FERTILITY CENTER ” Practice Location

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