Provider Demographics
NPI:1952934556
Name:FAMILY FERTILITY CRYOBANK
Entity Type:Organization
Organization Name:FAMILY FERTILITY CRYOBANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-919-9540
Mailing Address - Street 1:6699 ALVARADO RD STE 2208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5240
Mailing Address - Country:US
Mailing Address - Phone:619-286-3520
Mailing Address - Fax:619-265-1429
Practice Address - Street 1:6699 ALVARADO RD STE 2208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5240
Practice Address - Country:US
Practice Address - Phone:619-286-3520
Practice Address - Fax:619-265-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790969016OtherKAISER