05D1052088 CLIA NUMBER - DIAGNOSTIC AND INTERVENTIONAL SURGICAL CENTER

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Laboratory Demographics

CLIA Number: 05D1052088

Facility Name: DIAGNOSTIC AND INTERVENTIONAL SURGICAL CENTER

Facility Address:
13160 MINDANAO WAY STE 150
MARINA DEL REY, CA
ZIP 90292
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Facility Phone Number: 310 574-0440

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1740337435

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1052088
LAB Type	Ambulatory Surgery Center
Facility Name	DIAGNOSTIC AND INTERVENTIONAL SURGICAL CENTER
Street	13160 MINDANAO WAY STE 150
City	MARINA DEL REY
State	CA
ZIP	90292
Phone	310 574-0440
CertificateType	4
CertificateEffectiveDate	3/16/2024
CertificateExpirationDate	3/15/2026
FacilityType	Waiver

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