05D0865235 CLIA NUMBER - SAN GABRIEL VALLEY SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 05D0865235
  • Facility Name: SAN GABRIEL VALLEY SURGICAL CENTER
  • Facility Address: 1250 SOUTH SUNSET AVE, SUITE 100
    WEST COVINA, CA
    ZIP 91790
  • Facility Phone: 818 960-6623
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: THOMAS O. BRYAN
  • NPI Number: 1790934834
  • Taxonomy: 261QS1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0865235
LAB Type Ambulatory Surgery Center
Facility Name SAN GABRIEL VALLEY SURGICAL CENTER
Street 1250 SOUTH SUNSET AVE, SUITE 100
City WEST COVINA
State CA
ZIP 91790
Phone 818 960-6623
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director THOMAS O. BRYAN

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This page was last updated on: 9/29/2025