05D1065144 CLIA NUMBER - AZUSA SURGERY CENTER INC A MEDICAL CORPORATION

Laboratory Demographics

CLIA Number: 05D1065144

Facility Name: AZUSA SURGERY CENTER INC A MEDICAL CORPORATION

Facility Address:
830 S CITRUS AVE STE 101
AZUSA, CA
ZIP 91702
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Facility Phone Number: 626 543-1560

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1114043858

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1065144
LAB Type	Ambulatory Surgery Center
Facility Name	AZUSA SURGERY CENTER INC A MEDICAL CORPORATION
Street	830 S CITRUS AVE STE 101
City	AZUSA
State	CA
ZIP	91702
Phone	626 543-1560
CertificateType	4
CertificateEffectiveDate	2/22/2023
CertificateExpirationDate	2/21/2025
FacilityType	Waiver

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