Provider Demographics
NPI:1225631484
Name:FERTILITY LAB SCIENCES OF ORANGE COUNTY, LLC
Entity Type:Organization
Organization Name:FERTILITY LAB SCIENCES OF ORANGE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-968-1950
Mailing Address - Street 1:9380 STATION ST
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6831
Mailing Address - Country:US
Mailing Address - Phone:860-303-8855
Mailing Address - Fax:
Practice Address - Street 1:3501 JAMBOREE RD STE 450
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2916
Practice Address - Country:US
Practice Address - Phone:949-531-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2089497OtherCLIA