05D1035143 CLIA NUMBER - ADVANCED AMBULATORY SURGERY CENTER LP

Laboratory Demographics

CLIA Number: 05D1035143

Facility Name: ADVANCED AMBULATORY SURGERY CENTER LP

Facility Address:
1901 W LUGONIA AVE SUITE 100
REDLANDS, CA
ZIP 92374
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Facility Phone Number: 909 557-1700

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1881690949

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1035143
LAB Type	Ambulatory Surgery Center
Facility Name	ADVANCED AMBULATORY SURGERY CENTER LP
Street	1901 W LUGONIA AVE SUITE 100
City	REDLANDS
State	CA
ZIP	92374
Phone	909 557-1700
CertificateType	4
CertificateEffectiveDate	12/21/2022
CertificateExpirationDate	12/20/2024
FacilityType	Waiver

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