05D1088405 CLIA NUMBER - MONTEBELLO ARTIFICIAL KIDNEY CENTER

Laboratory Demographics

CLIA Number: 05D1088405

Facility Name: MONTEBELLO ARTIFICIAL KIDNEY CENTER

Facility Address:
3404 W BEVERLY BLVD
MONTEBELLO, CA
ZIP 90640
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Facility Phone Number: 323 728-7580

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1790960060

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1088405
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MONTEBELLO ARTIFICIAL KIDNEY CENTER
Street	3404 W BEVERLY BLVD
City	MONTEBELLO
State	CA
ZIP	90640
Phone	323 728-7580
CertificateType	4
CertificateEffectiveDate	8/25/2022
CertificateExpirationDate	8/24/2024
FacilityType	Waiver

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