Provider Demographics
NPI:1659812790
Name:FERTILIFE ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:FERTILIFE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YI TING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-639-3538
Mailing Address - Street 1:2525 E COLORADO BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3771
Mailing Address - Country:US
Mailing Address - Phone:626-639-3538
Mailing Address - Fax:626-639-3538
Practice Address - Street 1:2525 E COLORADO BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3771
Practice Address - Country:US
Practice Address - Phone:626-639-3538
Practice Address - Fax:626-639-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty