05D1050971 CLIA NUMBER - SIERRA AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D1050971

Facility Name: SIERRA AMBULATORY SURGERY CENTER

Facility Address:
400 SIERRA COLLEGE DRIVE, STE B
GRASS VALLEY, CA
ZIP 95945
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Facility Phone Number: 530 272-3428

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1043254063

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1050971
LAB Type	Ambulatory Surgery Center
Facility Name	SIERRA AMBULATORY SURGERY CENTER
Street	400 SIERRA COLLEGE DRIVE, STE B
City	GRASS VALLEY
State	CA
ZIP	95945
Phone	530 272-3428
CertificateType	4
CertificateEffectiveDate	2/16/2024
CertificateExpirationDate	2/15/2026
FacilityType	Waiver

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