05D1007646 CLIA NUMBER - MIRAGE ENDOSCOPY CENTER LP

Laboratory Demographics

  • CLIA Code: 05D1007646
  • Facility Name: MIRAGE ENDOSCOPY CENTER LP
  • Facility Address: 39-935 VISTA DEL SOL, SUITE 101
    RANCHO MIRAGE, CA
    ZIP 92270
  • Facility Phone: 760 837-9210
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: GARY M. ANNUNZIATA
  • NPI Number: 1588668503
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D1007646
LAB Type Ambulatory Surgery Center
Facility Name MIRAGE ENDOSCOPY CENTER LP
Street 39-935 VISTA DEL SOL, SUITE 101
City RANCHO MIRAGE
State CA
ZIP 92270
Phone 760 837-9210
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/24/2024
Certificate Expiration Date 12/23/2026
Facility Type Ambulatory Surgery Center
Lab Director GARY M. ANNUNZIATA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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