Provider Demographics
NPI:1245249853
Name:LAUREL FERTILITY CARE
Entity type:Organization
Organization Name:LAUREL FERTILITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMIKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-673-9199
Mailing Address - Street 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 570
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4586
Mailing Address - Country:US
Mailing Address - Phone:415-673-9199
Mailing Address - Fax:415-673-8796
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 570
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4586
Practice Address - Country:US
Practice Address - Phone:415-673-9199
Practice Address - Fax:415-673-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79169207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66561Medicare UPIN