05D1010969 CLIA NUMBER - MED-LASER SURGICAL CENTER, LLC

Laboratory Demographics

CLIA Number: 05D1010969

Facility Name: MED-LASER SURGICAL CENTER, LLC

Facility Address:
2445 W WHITTIER BLVD SUITE 100
MONTEBELLO, CA
ZIP 90640
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Facility Phone Number: 323 727-2550

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1538178256

Taxonomy: 261QS0132X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1010969
LAB Type	Ambulatory Surgery Center
Facility Name	MED-LASER SURGICAL CENTER, LLC
Street	2445 W WHITTIER BLVD SUITE 100
City	MONTEBELLO
State	CA
ZIP	90640
Phone	323 727-2550
CertificateType	4
CertificateEffectiveDate	3/28/2023
CertificateExpirationDate	3/27/2025
FacilityType	Waiver

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