05D1083833 CLIA NUMBER - DIALYSIS CENTER OF ONTARIO, LLC

Laboratory Demographics

CLIA Number: 05D1083833

Facility Name: DIALYSIS CENTER OF ONTARIO, LLC

Facility Address:
2850 INLAND EMPIRE BLVD BUILDING C
ONTARIO, CA
ZIP 91764
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Facility Phone Number: 909 476-2638

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1356549455

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1083833
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CENTER OF ONTARIO, LLC
Street	2850 INLAND EMPIRE BLVD BUILDING C
City	ONTARIO
State	CA
ZIP	91764
Phone	909 476-2638
CertificateType	4
CertificateEffectiveDate	5/12/2024
CertificateExpirationDate	5/11/2026
FacilityType	Waiver

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