Provider Demographics
NPI:1043588767
Name:PETER UZELAC MD, INC
Entity Type:Organization
Organization Name:PETER UZELAC MD, INC
Other - Org Name:MARIN FERTILITY CENTER, NAPA VALLEY FERTILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:STEVAN
Authorized Official - Last Name:UZELAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-9409
Mailing Address - Street 1:1100 S ELISEO DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2017
Mailing Address - Country:US
Mailing Address - Phone:415-925-9409
Mailing Address - Fax:415-945-9410
Practice Address - Street 1:1100 S ELISEO DR
Practice Address - Street 2:SUITE 107
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2017
Practice Address - Country:US
Practice Address - Phone:415-925-9409
Practice Address - Fax:415-945-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72448174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty