05D2019817 CLIA NUMBER - ATHENIX BODY SCULPTING INSTITUTE OF IRVINE

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Laboratory Demographics

CLIA Number: 05D2019817

Facility Name: ATHENIX BODY SCULPTING INSTITUTE OF IRVINE

Facility Address:
113 WATERWORKS WAY STE 300
IRVINE, CA
ZIP 92618
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Facility Phone Number: 949 450-0880

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1629482609

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2019817
LAB Type	Ambulatory Surgery Center
Facility Name	ATHENIX BODY SCULPTING INSTITUTE OF IRVINE
Street	113 WATERWORKS WAY STE 300
City	IRVINE
State	CA
ZIP	92618
Phone	949 450-0880
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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