05D1094024 CLIA NUMBER - MIRAGE SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D1094024

Facility Name: MIRAGE SURGERY CENTER

Facility Address:
71-949 HWY 111, STE 300
RANCHO MIRAGE, CA
ZIP 92270
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Facility Phone Number: 760 568-2211

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1932350238

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1094024
LAB Type	Ambulatory Surgery Center
Facility Name	MIRAGE SURGERY CENTER
Street	71-949 HWY 111, STE 300
City	RANCHO MIRAGE
State	CA
ZIP	92270
Phone	760 568-2211
CertificateType	4
CertificateEffectiveDate	1/8/2023
CertificateExpirationDate	1/7/2025
FacilityType	Waiver

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