Provider Demographics
NPI:1366296204
Name:FOYOUZI REPRODUCTIVE GENETIC MEDICAL CORPORATION
Entity type:Organization
Organization Name:FOYOUZI REPRODUCTIVE GENETIC MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NASTARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOYOUZI-YOUSEFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-907-6910
Mailing Address - Street 1:1371 CAMINITO BALADA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7184
Mailing Address - Country:US
Mailing Address - Phone:203-907-6910
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B225
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1709
Practice Address - Country:US
Practice Address - Phone:203-907-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty