MEDICARE: LABRYO 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	207V00000X	Obstetrics & Gynecology Physician
2	207VE0102X	Reproductive Endocrinology Physician

General Provider Information

NPI Number	:	1780333062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABRYO FERTILITY CENTER

Provider Business Mailing Address
First Line	:	2001 WESTCLIFF DR STE 300
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	949-891-1531
Fax Number	:	949-891-0110

Provider Business Practice Location Address
First Line	:	2001 WESTCLIFF DR STE 300
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	949-891-1531
Fax Number	:	949-891-0110

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	BENITO VILLANUEVA
Credential	:	MD
Telephone Number	:	949-891-1531

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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Directions to “LABRYO FERTILITY CENTER ” Practice Location

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