05D2013939 CLIA NUMBER - ANAHEIM WEST DIALYSIS

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Laboratory Demographics

CLIA Number: 05D2013939

Facility Name: ANAHEIM WEST DIALYSIS

Facility Address:
1821 WEST LINCOLN AVE
ANAHEIM, CA
ZIP 92801
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Facility Phone Number: 714 765-6510

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1033449459

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2013939
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ANAHEIM WEST DIALYSIS
Street	1821 WEST LINCOLN AVE
City	ANAHEIM
State	CA
ZIP	92801
Phone	714 765-6510
CertificateType	4
CertificateEffectiveDate	9/28/2022
CertificateExpirationDate	9/27/2024
FacilityType	Waiver

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