05D0978359 CLIA NUMBER - SAN YSIDRO DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 05D0978359

Facility Name: SAN YSIDRO DIALYSIS CENTER

Facility Address:
1445 30TH ST STE A
SAN DIEGO, CA
ZIP 92154
Get Directions

Facility Phone Number: 619 575-3901

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1295700201

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0978359
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SAN YSIDRO DIALYSIS CENTER
Street	1445 30TH ST STE A
City	SAN DIEGO
State	CA
ZIP	92154
Phone	619 575-3901
CertificateType	4
CertificateEffectiveDate	10/5/2023
CertificateExpirationDate	10/4/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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