Provider Demographics
NPI:1114686862
Name:AMERICAN FERTILITY CALIFORNIA CORP
Entity Type:Organization
Organization Name:AMERICAN FERTILITY CALIFORNIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-777-8888
Mailing Address - Street 1:1370 VALLEY VISTA DR STE 135
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3950
Mailing Address - Country:US
Mailing Address - Phone:097-777-8888
Mailing Address - Fax:909-551-0200
Practice Address - Street 1:1370 VALLEY VISTA DR STE 135
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3950
Practice Address - Country:US
Practice Address - Phone:909-777-8888
Practice Address - Fax:909-551-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FERTILITY MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty