05D1005021 CLIA NUMBER - POWAY CA MULTI SPECIALTY ASC LLC DBA POWAY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D1005021
  • Facility Name: POWAY CA MULTI SPECIALTY ASC LLC DBA POWAY SURGERY CENTER
  • Facility Address: 15611 POMERADO RD STE 220
    POWAY, CA
    ZIP 92064
  • Facility Phone: 858 521-0031
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRAD COHEN
  • NPI Number: 1598949281
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1005021
LAB Type Ambulatory Surgery Center
Facility Name POWAY CA MULTI SPECIALTY ASC LLC DBA POWAY SURGERY CENTER
Street 15611 POMERADO RD STE 220
City POWAY
State CA
ZIP 92064
Phone 858 521-0031
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Ambulatory Surgery Center
Lab Director BRAD COHEN

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