05D1036297 CLIA NUMBER - ONTARIO DIALYSIS

Laboratory Demographics

CLIA Number: 05D1036297

Facility Name: ONTARIO DIALYSIS

Facility Address:
1950 S GROVE AVE STE 101
ONTARIO, CA
ZIP 91761
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Facility Phone Number: 909 930-5566

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184687345

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1036297
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ONTARIO DIALYSIS
Street	1950 S GROVE AVE STE 101
City	ONTARIO
State	CA
ZIP	91761
Phone	909 930-5566
CertificateType	4
CertificateEffectiveDate	1/25/2023
CertificateExpirationDate	1/24/2025
FacilityType	Waiver

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