Provider Demographics
NPI:1093891152
Name:SAN DIEGO CENTER FOR REPRODUCTIVE SURGERY
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR REPRODUCTIVE SURGERY
Other - Org Name:SAN DIEGO CENTER FOR REPRODUCTIVE SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-505-5500
Mailing Address - Street 1:8010 FROST ST
Mailing Address - Street 2:PLAZA LEVEL
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2778
Mailing Address - Country:US
Mailing Address - Phone:858-505-5500
Mailing Address - Fax:858-505-5555
Practice Address - Street 1:8010 FROST ST
Practice Address - Street 2:PLAZA LEVEL
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2778
Practice Address - Country:US
Practice Address - Phone:858-505-5500
Practice Address - Fax:858-505-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48365207VE0102X
261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA48365COtherMEDICARE ID FOR ARLENE J. MORALES MD
CAE99573Medicare UPIN
CAS051781Medicare PIN