05D1086139 CLIA NUMBER - SADDLEBACK PAIN AND SURGICAL CENTER

Laboratory Demographics

CLIA Number: 05D1086139

Facility Name: SADDLEBACK PAIN AND SURGICAL CENTER

Facility Address:
23521 PASEO DE VALENCIA SUITE 204
LAGUNA HILLS, CA
ZIP 92653
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Facility Phone Number: 626 922-7100

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1578160636

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1086139
LAB Type	Ambulatory Surgery Center
Facility Name	SADDLEBACK PAIN AND SURGICAL CENTER
Street	23521 PASEO DE VALENCIA SUITE 204
City	LAGUNA HILLS
State	CA
ZIP	92653
Phone	626 922-7100
CertificateType	4
CertificateEffectiveDate	7/3/2022
CertificateExpirationDate	7/2/2024
FacilityType	Waiver

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