05D1022612 CLIA NUMBER - GLENDORA CA ENDOSCOPY ASC LP

Laboratory Demographics

  • CLIA Code: 05D1022612
  • Facility Name: GLENDORA CA ENDOSCOPY ASC LP
  • Facility Address: 1794 S BARRANCA AVE
    GLENDORA, CA
    ZIP 91740
  • Facility Phone: 626 858-4600
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SHAHNAWAZ S. JAFFER
  • NPI Number: 1972654762
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1022612
LAB Type Ambulatory Surgery Center
Facility Name GLENDORA CA ENDOSCOPY ASC LP
Street 1794 S BARRANCA AVE
City GLENDORA
State CA
ZIP 91740
Phone 626 858-4600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Ambulatory Surgery Center
Lab Director SHAHNAWAZ S. JAFFER

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This page was last updated on: 6/4/2025