05D1092368 CLIA NUMBER - SAN MARCOS DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 05D1092368

Facility Name: SAN MARCOS DIALYSIS CENTER

Facility Address:
2135 MONTIEL RD BLDG B
SAN MARCOS, CA
ZIP 92069
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Facility Phone Number: 760 975-0170

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1255506036

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1092368
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SAN MARCOS DIALYSIS CENTER
Street	2135 MONTIEL RD BLDG B
City	SAN MARCOS
State	CA
ZIP	92069
Phone	760 975-0170
CertificateType	4
CertificateEffectiveDate	11/21/2022
CertificateExpirationDate	11/20/2024
FacilityType	Waiver

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