05D0953714 CLIA NUMBER - UROLOGY ASSOCIATES OF THE CENTRAL COAST

Laboratory Demographics

CLIA Number: 05D0953714

Facility Name: UROLOGY ASSOCIATES OF THE CENTRAL COAST

Facility Address:
921 OAK PARK BLVD, STE 202
PISMO BEACH, CA
ZIP 93449
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Facility Phone Number: 805 786-2500

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1245637123

Taxonomy: 363AM0700X - Physician Assistant

CLIA Record

Field Name	Field Value
CLIA Number	05D0953714
LAB Type	Physician Office
Facility Name	UROLOGY ASSOCIATES OF THE CENTRAL COAST
Street	921 OAK PARK BLVD, STE 202
City	PISMO BEACH
State	CA
ZIP	93449
Phone	805 786-2500
CertificateType	3
CertificateEffectiveDate	11/9/2022
CertificateExpirationDate	11/8/2024
FacilityType	PPMP

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