Provider Demographics
NPI:1164853305
Name:REPRODUCTIVE SPECIALTY SURGERICAL CENTER, INC.
Entity Type:Organization
Organization Name:REPRODUCTIVE SPECIALTY SURGERICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-726-0648
Mailing Address - Street 1:15500 SAND CANYON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7709
Mailing Address - Country:US
Mailing Address - Phone:949-726-0600
Mailing Address - Fax:949-726-0601
Practice Address - Street 1:15500 SAND CANYON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7709
Practice Address - Country:US
Practice Address - Phone:949-726-0600
Practice Address - Fax:949-726-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4567261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0002020OtherCMS