05D1047986 CLIA NUMBER - PISMO BEACH DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D1047986
  • Facility Name: PISMO BEACH DIALYSIS
  • Facility Address: 320 JAMES WAY SUITE #110
    PISMO BEACH, CA
    ZIP 93449
  • Facility Phone: 805 556-0577
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BRIAN PENTON
  • NPI Number: 1144539586
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1047986
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PISMO BEACH DIALYSIS
Street 320 JAMES WAY SUITE #110
City PISMO BEACH
State CA
ZIP 93449
Phone 805 556-0577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BRIAN PENTON

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