Provider Demographics
NPI:1700034261
Name:SOUTHERN CALIFORNIA REPRODUCTIVE CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA REPRODUCTIVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:805-658-9112
Mailing Address - Street 1:450 N ROXBURY DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4226
Mailing Address - Country:US
Mailing Address - Phone:310-277-2393
Mailing Address - Fax:
Practice Address - Street 1:450 N ROXBURY DR STE 500
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4226
Practice Address - Country:US
Practice Address - Phone:310-277-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76116174400000X
CAA74590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty