05D1100524 CLIA NUMBER - GATEWAY PLAZA DIALYSIS

Laboratory Demographics

CLIA Number: 05D1100524

Facility Name: GATEWAY PLAZA DIALYSIS

Facility Address:
1580 W ROSECRANS AVE
COMPTON, CA
ZIP 90220
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Facility Phone Number: 310 631-3085

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1457599276

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1100524
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GATEWAY PLAZA DIALYSIS
Street	1580 W ROSECRANS AVE
City	COMPTON
State	CA
ZIP	90220
Phone	310 631-3085
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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