05D2002590 CLIA NUMBER - SATELLITE DIALYSIS OF WHITE ROAD LLC

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Laboratory Demographics

CLIA Number: 05D2002590

Facility Name: SATELLITE DIALYSIS OF WHITE ROAD LLC

Facility Address:
1450 SOUTH WHITE ROAD, SUITE 30 MALIKA FORD DWR
SAN JOSE, CA
ZIP 95127
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Facility Phone Number: 408 272-9810

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1972838944

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2002590
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SATELLITE DIALYSIS OF WHITE ROAD LLC
Street	1450 SOUTH WHITE ROAD, SUITE 30 MALIKA FORD DWR
City	SAN JOSE
State	CA
ZIP	95127
Phone	408 272-9810
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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