Provider Demographics
NPI:1831470830
Name:VALLEY CENTER FOR REPRODUCTIVE HEALTH INC
Entity Type:Organization
Organization Name:VALLEY CENTER FOR REPRODUCTIVE HEALTH INC
Other - Org Name:WEST COAST WOMENS REPRODUCTIVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOPERSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-986-1648
Mailing Address - Street 1:4835 VAN NUYS BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2109
Mailing Address - Country:US
Mailing Address - Phone:818-986-1648
Mailing Address - Fax:818-986-1653
Practice Address - Street 1:4835 VAN NUYS BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2109
Practice Address - Country:US
Practice Address - Phone:818-986-1648
Practice Address - Fax:818-986-1653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY CENTER FOR REPRODUCTIVE HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-02
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69869OtherLICENSE