Provider Demographics
NPI:1679963912
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:BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-908-9375
Mailing Address - Street 1:9800 MT PYRAMID CT STE 400
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2669
Mailing Address - Country:US
Mailing Address - Phone:303-908-9375
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:92660-2939
Practice Address - Country:US
Practice Address - Phone:303-908-9375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical