05D1073791 CLIA NUMBER - MD SURGICAL SOLUTIONS LLC

Laboratory Demographics

CLIA Number: 05D1073791

Facility Name: MD SURGICAL SOLUTIONS LLC

Facility Address:
15477 VENTURA BLVD STE 103
SHERMAN OAKS, CA
ZIP 91403
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Facility Phone Number: 818 641-1214

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1134327182

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1073791
LAB Type	Ambulatory Surgery Center
Facility Name	MD SURGICAL SOLUTIONS LLC
Street	15477 VENTURA BLVD STE 103
City	SHERMAN OAKS
State	CA
ZIP	91403
Phone	818 641-1214
CertificateType	4
CertificateEffectiveDate	9/17/2023
CertificateExpirationDate	9/16/2025
FacilityType	Waiver

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