05D1012482 CLIA NUMBER - SDOSC LP

Laboratory Demographics

CLIA Number: 05D1012482

Facility Name: SDOSC LP

Facility Address:
3939 RUFFIN ROAD, SUITE 101
SAN DIEGO, CA
ZIP 92123
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Facility Phone Number: 619 299-9530

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1942261599

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1012482
LAB Type	Ambulatory Surgery Center
Facility Name	SDOSC LP
Street	3939 RUFFIN ROAD, SUITE 101
City	SAN DIEGO
State	CA
ZIP	92123
Phone	619 299-9530
CertificateType	4
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	Waiver

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