05D0894012 CLIA NUMBER - NORTHRIDGE ADVANCED SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D0894012

Facility Name: NORTHRIDGE ADVANCED SURGERY CENTER

Facility Address:
8331 RESEDA BOULEVARD
NORTHRIDGE, CA
ZIP 91324
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Facility Phone Number: 818 993-3428

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1417971821

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0894012
LAB Type	Ambulatory Surgery Center
Facility Name	NORTHRIDGE ADVANCED SURGERY CENTER
Street	8331 RESEDA BOULEVARD
City	NORTHRIDGE
State	CA
ZIP	91324
Phone	818 993-3428
CertificateType	4
CertificateEffectiveDate	11/3/2022
CertificateExpirationDate	11/2/2024
FacilityType	Waiver

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