Provider Demographics
NPI:1699327049
Name:EDEN FERTILITY MANAGEMENT, LLC
Entity type:Organization
Organization Name:EDEN FERTILITY MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-318-0189
Mailing Address - Street 1:2720 N HARBOR BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2626
Mailing Address - Country:US
Mailing Address - Phone:714-278-4705
Mailing Address - Fax:
Practice Address - Street 1:2720 N HARBOR BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2626
Practice Address - Country:US
Practice Address - Phone:626-318-0189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDEN FERTILITY MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty