05D1005799 CLIA NUMBER - GARDEN GROVE OUTPATIENT SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D1005799

Facility Name: GARDEN GROVE OUTPATIENT SURGERY CENTER

Facility Address:
13132 MAGNOLIA ST STE B
GARDEN GROVE, CA
ZIP 92844
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Facility Phone Number: 714 590-1452

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1740381078

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1005799
LAB Type	Ambulatory Surgery Center
Facility Name	GARDEN GROVE OUTPATIENT SURGERY CENTER
Street	13132 MAGNOLIA ST STE B
City	GARDEN GROVE
State	CA
ZIP	92844
Phone	714 590-1452
CertificateType	4
CertificateEffectiveDate	10/30/2022
CertificateExpirationDate	10/29/2024
FacilityType	Waiver

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