MEDICARE: FAMILY FERTILITY CRYOBANK

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790969016	OTHER	CA	KAISER

General Provider Information

NPI Number	:	1952934556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FERTILITY CRYOBANK

Provider Business Mailing Address
First Line	:	6699 ALVARADO RD STE 2208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5240
Country	:	US
Telephone Number	:	619-286-3520
Fax Number	:	619-265-1429

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD STE 2208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5240
Country	:	US
Telephone Number	:	619-286-3520
Fax Number	:	619-265-1429

Authorized Official
Title or Position	:	COO
Name	:	MEL I COHEN
Credential	:	PHD
Telephone Number	:	303-919-9540

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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Directions to “FAMILY FERTILITY CRYOBANK ” Practice Location

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