05D1067396 CLIA NUMBER - RENAISSANCE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D1067396
  • Facility Name: RENAISSANCE SURGERY CENTER
  • Facility Address: 2365 E FIR AVE
    FRESNO, CA
    ZIP 93720
  • Facility Phone: 559 797-9100
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JONATHAN D. GROSSMAN MD
  • NPI Number: 1013068642
  • Taxonomy: 261QA1903X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Ambulatory Surgery Center
Lab Director JONATHAN D. GROSSMAN MD

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This page was last updated on: 6/4/2025