05D1067396 CLIA NUMBER - RENAISSANCE SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D1067396

Facility Name: RENAISSANCE SURGERY CENTER

Facility Address:
2365 E FIR AVE
FRESNO, CA
ZIP 93720
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Facility Phone Number: 559 797-9100

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1013068642

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1067396
LAB Type	Ambulatory Surgery Center
Facility Name	RENAISSANCE SURGERY CENTER
Street	2365 E FIR AVE
City	FRESNO
State	CA
ZIP	93720
Phone	559 797-9100
CertificateType	4
CertificateEffectiveDate	4/17/2023
CertificateExpirationDate	4/16/2025
FacilityType	Waiver

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