05D1036267 CLIA NUMBER - ARCHIBALD SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D1036267
  • Facility Name: ARCHIBALD SURGERY CENTER, LLC
  • Facility Address: 9674 ARCHIBALD AVE STE 125
    RANCHO CUCAMONGA, CA
    ZIP 91730
  • Facility Phone: 909 989-4100
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SUNIL M. SHIVARAM
  • NPI Number: 1982975959
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1036267
LAB Type Ambulatory Surgery Center
Facility Name ARCHIBALD SURGERY CENTER, LLC
Street 9674 ARCHIBALD AVE STE 125
City RANCHO CUCAMONGA
State CA
ZIP 91730
Phone 909 989-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Ambulatory Surgery Center
Lab Director SUNIL M. SHIVARAM

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This page was last updated on: 9/29/2025