05D1086277 CLIA NUMBER - PERITONEAL DIALYSIS CENTER OF AMERICA INC

Laboratory Demographics

  • CLIA Code: 05D1086277
  • Facility Name: PERITONEAL DIALYSIS CENTER OF AMERICA INC
  • Facility Address: 3112 W BEVERLY BLVD
    MONTEBELLO, CA
    ZIP 90640
  • Facility Phone: 323 722-2053
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. CARLOS R. GONZALEZ
  • NPI Number: 1750495669
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1086277
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PERITONEAL DIALYSIS CENTER OF AMERICA INC
Street 3112 W BEVERLY BLVD
City MONTEBELLO
State CA
ZIP 90640
Phone 323 722-2053
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. CARLOS R. GONZALEZ

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This page was last updated on: 9/29/2025