Provider Demographics
NPI:1114035664
Name:SOUTHERN CALIFORNIA INSTITUTE FOR REPRODUCTIVE SCIENCES
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA INSTITUTE FOR REPRODUCTIVE SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-642-8727
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:SUITE 433
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-642-8727
Mailing Address - Fax:949-642-5413
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:SUITE 433
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-642-8727
Practice Address - Fax:949-642-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory