05D1102470 CLIA NUMBER - SOUTH COUNTY PAIN & REHAB

Laboratory Demographics

CLIA Number: 05D1102470

Facility Name: SOUTH COUNTY PAIN & REHAB

Facility Address:
700 W 6TH STREET, SUITE R
GILROY, CA
ZIP 95020
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Facility Phone Number: 408 842-9296

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811934607

Taxonomy: 225400000X - Rehabilitation Practitioner
A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

CLIA Record

Field Name	Field Value
CLIA Number	05D1102470
LAB Type	Physician Office
Facility Name	SOUTH COUNTY PAIN & REHAB
Street	700 W 6TH STREET, SUITE R
City	GILROY
State	CA
ZIP	95020
Phone	408 842-9296
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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