05D0919937 CLIA NUMBER - PENINSULA ENDOSCOPY CENTER LLC

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Laboratory Demographics

CLIA Number: 05D0919937

Facility Name: PENINSULA ENDOSCOPY CENTER LLC

Facility Address:
1720 EL CAMINO REAL STE 100
BURLINGAME, CA
ZIP 94010
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Facility Phone Number: 650 373-1970

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1548583651

Taxonomy: 261QE0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0919937
LAB Type	Ambulatory Surgery Center
Facility Name	PENINSULA ENDOSCOPY CENTER LLC
Street	1720 EL CAMINO REAL STE 100
City	BURLINGAME
State	CA
ZIP	94010
Phone	650 373-1970
CertificateType	4
CertificateEffectiveDate	8/10/2023
CertificateExpirationDate	8/9/2025
FacilityType	Waiver

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