05D1063242 CLIA NUMBER - INGLEWOOD IMAGING CENTER LLC

Laboratory Demographics

CLIA Number: 05D1063242

Facility Name: INGLEWOOD IMAGING CENTER LLC

Facility Address:
211 N PRAIRIE AVE SUITE E
INGLEWOOD, CA
ZIP 90301
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Facility Phone Number: 310 672-9729

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1407868417

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1063242
LAB Type	Other
Facility Name	INGLEWOOD IMAGING CENTER LLC
Street	211 N PRAIRIE AVE SUITE E
City	INGLEWOOD
State	CA
ZIP	90301
Phone	310 672-9729
CertificateType	4
CertificateEffectiveDate	1/9/2023
CertificateExpirationDate	1/8/2025
FacilityType	Waiver

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