05D1019193 CLIA NUMBER - FOOTHILL SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D1019193

Facility Name: FOOTHILL SURGERY CENTER

Facility Address:
255 E SANTA CLARA STREET SUITE 110
ARCADIA, CA
ZIP 91006
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Facility Phone Number: 818 956-1010

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1144499633

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1019193
LAB Type	Ambulatory Surgery Center
Facility Name	FOOTHILL SURGERY CENTER
Street	255 E SANTA CLARA STREET SUITE 110
City	ARCADIA
State	CA
ZIP	91006
Phone	818 956-1010
CertificateType	4
CertificateEffectiveDate	11/12/2023
CertificateExpirationDate	11/11/2025
FacilityType	Waiver

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