Provider Demographics
NPI:1043589393
Name:PACIFIC REPRODUCTIVE SERVICES, INC.
Entity Type:Organization
Organization Name:PACIFIC REPRODUCTIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TISSUE BANK DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP
Authorized Official - Phone:626-432-1681
Mailing Address - Street 1:444 DE HARO ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 DE HARO ST
Practice Address - Street 2:SUITE 222
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2347
Practice Address - Country:US
Practice Address - Phone:415-487-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702360367A00000X
CA391696367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty