05D1002011 CLIA NUMBER - SAN DIEGO CA MULTI SPECIALTY ASC LLC DBA MISSION VALLEY HEIGHTS SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D1002011

Facility Name: SAN DIEGO CA MULTI SPECIALTY ASC LLC DBA MISSION VALLEY HEIGHTS SURGERY CENTER

Facility Address:
7485 MISSION VALLEY ROAD STE 106
SAN DIEGO, CA
ZIP 92108
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Facility Phone Number: 619 291-3737

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1699959387

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1002011
LAB Type	Ambulatory Surgery Center
Facility Name	SAN DIEGO CA MULTI SPECIALTY ASC LLC DBA MISSION VALLEY HEIGHTS SURGERY CENTER
Street	7485 MISSION VALLEY ROAD STE 106
City	SAN DIEGO
State	CA
ZIP	92108
Phone	619 291-3737
CertificateType	4
CertificateEffectiveDate	7/25/2022
CertificateExpirationDate	7/24/2024
FacilityType	Waiver

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