Provider Demographics
NPI:1164901237
Name:GEN 5 FERTILITY CENTER, P.C.
Entity Type:Organization
Organization Name:GEN 5 FERTILITY CENTER, P.C.
Other - Org Name:GEN 5 FERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-267-4365
Mailing Address - Street 1:3420 CARMEL MOUNTAIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1069
Mailing Address - Country:US
Mailing Address - Phone:858-267-4365
Mailing Address - Fax:
Practice Address - Street 1:3420 CARMEL MOUNTAIN RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1069
Practice Address - Country:US
Practice Address - Phone:858-267-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68058207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty