Provider Demographics
NPI:1073973558
Name:GONDRA CENTER FOR IVF LABORATORIES
Entity Type:Organization
Organization Name:GONDRA CENTER FOR IVF LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-240-8815
Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:STE B210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4265
Mailing Address - Country:US
Mailing Address - Phone:480-621-6203
Mailing Address - Fax:480-621-6331
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:STE B210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4265
Practice Address - Country:US
Practice Address - Phone:480-621-6203
Practice Address - Fax:480-621-6331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GONDRA CENTER FOR REPRODUCTIVE CARE & ADVANCED GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44933291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory