05D0959381 CLIA NUMBER - RAI-WEST C-COLTON

Laboratory Demographics

CLIA Number: 05D0959381

Facility Name: RAI-WEST C-COLTON

Facility Address:
1275 WEST C DR
COLTON, CA
ZIP 92324
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Facility Phone Number: 909 430-0930

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1790835031

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0959381
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RAI-WEST C-COLTON
Street	1275 WEST C DR
City	COLTON
State	CA
ZIP	92324
Phone	909 430-0930
CertificateType	4
CertificateEffectiveDate	5/25/2023
CertificateExpirationDate	5/24/2025
FacilityType	Waiver

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