Provider Demographics
NPI:1396961082
Name:LA IVF LAB LLC.
Entity type:Organization
Organization Name:LA IVF LAB LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAMRAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-888-8874
Mailing Address - Street 1:250 N ROBERTSON BLVD
Mailing Address - Street 2:#403
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1788
Mailing Address - Country:US
Mailing Address - Phone:310-888-8874
Mailing Address - Fax:310-285-0334
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:#403
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-888-8874
Practice Address - Fax:310-285-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11205291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory