Provider Demographics
NPI:1245441419
Name:REPRODUCTIVE WELLNESS
Entity type:Organization
Organization Name:REPRODUCTIVE WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR & VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:SKLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DA (RI)
Authorized Official - Phone:619-265-0291
Mailing Address - Street 1:2820 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:858-381-2281
Mailing Address - Fax:619-546-5815
Practice Address - Street 1:2820 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-381-2281
Practice Address - Fax:618-546-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9332171100000X
CA9603171100000X
CAAC9332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710025267Medicare UPIN
CA1144372921Medicare UPIN