05D0955186 CLIA NUMBER - PACIFIC SURIGICAL INSTITUTE OF PAIN MANAGEMENT INC

Laboratory Demographics

CLIA Number: 05D0955186

Facility Name: PACIFIC SURIGICAL INSTITUTE OF PAIN MANAGEMENT INC

Facility Address:
3703 CAMINO DEL RIO SO STE 101
SAN DIEGO, CA
ZIP 92108
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Facility Phone Number: 619 282-0185

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1528130879

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0955186
LAB Type	Ambulatory Surgery Center
Facility Name	PACIFIC SURIGICAL INSTITUTE OF PAIN MANAGEMENT INC
Street	3703 CAMINO DEL RIO SO STE 101
City	SAN DIEGO
State	CA
ZIP	92108
Phone	619 282-0185
CertificateType	4
CertificateEffectiveDate	12/21/2022
CertificateExpirationDate	12/20/2024
FacilityType	Waiver

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