03D2043699 CLIA NUMBER - MOSHARRAFA OUTPATIENT SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 03D2043699

Facility Name: MOSHARRAFA OUTPATIENT SURGERY CENTER, LLC

Facility Address:
4611 E SHEA BLVD, STE 100
PHOENIX, AZ
ZIP 85028
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Facility Phone Number: 602 996-4713

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639435886

Taxonomy: 2086S0122X - Surgery
A surgeon who specializes in plastic and reconstructive surgery.

CLIA Record

Field Name	Field Value
CLIA Number	03D2043699
LAB Type	Ambulatory Surgery Center
Facility Name	MOSHARRAFA OUTPATIENT SURGERY CENTER, LLC
Street	4611 E SHEA BLVD, STE 100
City	PHOENIX
State	AZ
ZIP	85028
Phone	602 996-4713
CertificateType	4
CertificateEffectiveDate	7/9/2022
CertificateExpirationDate	7/8/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024