05D1062828 CLIA NUMBER - MAGNOLIA WEST DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D1062828
  • Facility Name: MAGNOLIA WEST DIALYSIS
  • Facility Address: 11161 MAGNOLIA AVE
    RIVERSIDE, CA
    ZIP 92505
  • Facility Phone: 951 351-8090
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: TAHER M. KHALIL MD
  • NPI Number: 1316971641
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1062828
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MAGNOLIA WEST DIALYSIS
Street 11161 MAGNOLIA AVE
City RIVERSIDE
State CA
ZIP 92505
Phone 951 351-8090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director TAHER M. KHALIL MD

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