Provider Demographics
NPI:1033546916
Name:REPRODUCTIVE PARTNERS MEDICAL GROUP LA JOLLA, INC
Entity Type:Organization
Organization Name:REPRODUCTIVE PARTNERS MEDICAL GROUP LA JOLLA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:GARZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-552-9177
Mailing Address - Street 1:9850 GENESEE AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1219
Mailing Address - Country:US
Mailing Address - Phone:858-552-9177
Mailing Address - Fax:858-552-9188
Practice Address - Street 1:9850 GENESEE AVE STE 800
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1219
Practice Address - Country:US
Practice Address - Phone:858-552-9177
Practice Address - Fax:858-552-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty