05D0924350 CLIA NUMBER - MONTCLAIR DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 05D0924350
  • Facility Name: MONTCLAIR DIALYSIS CENTER
  • Facility Address: 9142 MONTE VISTA AVENUE
    MONTCLAIR, CA
    ZIP 91763
  • Facility Phone: 909 626-6505
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JONARDI HANDOKO MD
  • NPI Number: 1992768329
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0924350
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MONTCLAIR DIALYSIS CENTER
Street 9142 MONTE VISTA AVENUE
City MONTCLAIR
State CA
ZIP 91763
Phone 909 626-6505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JONARDI HANDOKO MD

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This page was last updated on: 6/4/2025