05D0573013 CLIA NUMBER - VICTOR VALLEY DIALYSIS

Laboratory Demographics

CLIA Number: 05D0573013

Facility Name: VICTOR VALLEY DIALYSIS

Facility Address:
16049 KAMANA ROAD
APPLE VALLEY, CA
ZIP 92307
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Facility Phone Number: (760) 242-8311

Facility Type: END STAGE RENAL DISEASE DIALYSIS

Certificate Type: Waiver

NPI Number: 1861467607

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0573013
LAB Type	END STAGE RENAL DISEASE DIALYSIS
Facility Name	VICTOR VALLEY DIALYSIS
Street	16049 KAMANA ROAD
City	APPLE VALLEY
State	CA
ZIP	92307
Phone	(760) 242-8311

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This page was last updated on: 5/11/2023