05D1025785 CLIA NUMBER - IRVINE ENDOSCOPY AND SURGICAL INSTITUTE

Laboratory Demographics

CLIA Number: 05D1025785

Facility Name: IRVINE ENDOSCOPY AND SURGICAL INSTITUTE

Facility Address:
15825 LAGUNA CANYON ROAD SUITE 100
IRVINE, CA
ZIP 92618
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Facility Phone Number: 949 727-4330

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1578652152

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1025785
LAB Type	Ambulatory Surgery Center
Facility Name	IRVINE ENDOSCOPY AND SURGICAL INSTITUTE
Street	15825 LAGUNA CANYON ROAD SUITE 100
City	IRVINE
State	CA
ZIP	92618
Phone	949 727-4330
CertificateType	4
CertificateEffectiveDate	5/18/2022
CertificateExpirationDate	5/17/2024
FacilityType	Waiver

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