05D0937017 CLIA NUMBER - RAI FOOTHILLS BLVD-GLENDORA

Laboratory Demographics

CLIA Number: 05D0937017

Facility Name: RAI FOOTHILLS BLVD-GLENDORA

Facility Address:
120 WEST FOOTHILL BOULEVARD
GLENDORA, CA
ZIP 91741
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Facility Phone Number: 626 335-7551

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1861567620

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0937017
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RAI FOOTHILLS BLVD-GLENDORA
Street	120 WEST FOOTHILL BOULEVARD
City	GLENDORA
State	CA
ZIP	91741
Phone	626 335-7551
CertificateType	4
CertificateEffectiveDate	3/23/2023
CertificateExpirationDate	3/22/2025
FacilityType	Waiver

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