05D1059130 CLIA NUMBER - LONG BEACH HARBOR DIALYSIS

Laboratory Demographics

CLIA Number: 05D1059130

Facility Name: LONG BEACH HARBOR DIALYSIS

Facility Address:
1075 EAST PACIFIC COAST HIGHWAY
LONG BEACH, CA
ZIP 90806
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Facility Phone Number: 562 599-1511

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1215032404

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1059130
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LONG BEACH HARBOR DIALYSIS
Street	1075 EAST PACIFIC COAST HIGHWAY
City	LONG BEACH
State	CA
ZIP	90806
Phone	562 599-1511
CertificateType	4
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Waiver

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