05D1092781 CLIA NUMBER - SOUTH COAST OUTPATIENT SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D1092781
  • Facility Name: SOUTH COAST OUTPATIENT SURGERY CENTER
  • Facility Address: 1101 BAYSIDE DR, STE 100
    CORONA DEL MAR, CA
    ZIP 92625
  • Facility Phone: 949 999-8644
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: NICCOLE MICHAEL
  • NPI Number: 1699043596
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 05D1092781
LAB Type Ambulatory Surgery Center
Facility Name SOUTH COAST OUTPATIENT SURGERY CENTER
Street 1101 BAYSIDE DR, STE 100
City CORONA DEL MAR
State CA
ZIP 92625
Phone 949 999-8644
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Ambulatory Surgery Center
Lab Director NICCOLE MICHAEL

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