05D1000652 CLIA NUMBER - LAKE ELSINORE DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 05D1000652
  • Facility Name: LAKE ELSINORE DIALYSIS CENTER
  • Facility Address: 32291 MISSION TRAIL RD BLDG S
    LAKE ELSINORE, CA
    ZIP 92530
  • Facility Phone: 951 674-5050
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DAVID CHANG, MD
  • NPI Number: 1205895869
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1000652
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE ELSINORE DIALYSIS CENTER
Street 32291 MISSION TRAIL RD BLDG S
City LAKE ELSINORE
State CA
ZIP 92530
Phone 951 674-5050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DAVID CHANG, MD

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This page was last updated on: 9/29/2025