05D0953985 CLIA NUMBER - UPLAND OUTPATIENT SURGICAL CENTER, LP

Laboratory Demographics

CLIA Number: 05D0953985

Facility Name: UPLAND OUTPATIENT SURGICAL CENTER, LP

Facility Address:
1211 W 6TH ST
ONTARIO, CA
ZIP 91762
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Facility Phone Number: 909 247-9483

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1710945787

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0953985
LAB Type	Ambulatory Surgery Center
Facility Name	UPLAND OUTPATIENT SURGICAL CENTER, LP
Street	1211 W 6TH ST
City	ONTARIO
State	CA
ZIP	91762
Phone	909 247-9483
CertificateType	4
CertificateEffectiveDate	2/29/2024
CertificateExpirationDate	2/27/2026
FacilityType	Waiver

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