05D0962066 CLIA NUMBER - SAN JUAN CAPISTRANO SOUTH DIALYSIS

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Laboratory Demographics

CLIA Number: 05D0962066

Facility Name: SAN JUAN CAPISTRANO SOUTH DIALYSIS

Facility Address:
31736 RANCHO VIEJO RD, STE D
SAN JUAN CAPISTRANO, CA
ZIP 92675
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Facility Phone Number: 949 240-1454

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1447226204

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0962066
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SAN JUAN CAPISTRANO SOUTH DIALYSIS
Street	31736 RANCHO VIEJO RD, STE D
City	SAN JUAN CAPISTRANO
State	CA
ZIP	92675
Phone	949 240-1454
CertificateType	4
CertificateEffectiveDate	6/23/2023
CertificateExpirationDate	6/22/2025
FacilityType	Waiver

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