05D2012132 CLIA NUMBER - MID VALLEY SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 05D2012132

Facility Name: MID VALLEY SURGERY CENTER, LLC

Facility Address:
4682 ONTARIO MILLS PARKWAY
ONTARIO, CA
ZIP 91764
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Facility Phone Number: 909 204-3540

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1992022297

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2012132
LAB Type	Ambulatory Surgery Center
Facility Name	MID VALLEY SURGERY CENTER, LLC
Street	4682 ONTARIO MILLS PARKWAY
City	ONTARIO
State	CA
ZIP	91764
Phone	909 204-3540
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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