05D1103182 CLIA NUMBER - ST JOSEPH SATELLITE HEALTHCARE

Laboratory Demographics

CLIA Number: 05D1103182

Facility Name: ST JOSEPH SATELLITE HEALTHCARE

Facility Address:
2212 E 4TH STREET SUITE 101
SANTA ANA, CA
ZIP 92705
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Facility Phone Number: 714 771-8000

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1609850320

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1103182
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ST JOSEPH SATELLITE HEALTHCARE
Street	2212 E 4TH STREET SUITE 101
City	SANTA ANA
State	CA
ZIP	92705
Phone	714 771-8000
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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