05D2029742 CLIA NUMBER - RICHMOND DIALYSIS

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Laboratory Demographics

CLIA Number: 05D2029742

Facility Name: RICHMOND DIALYSIS

Facility Address:
4200 MACDONALD AVENUE, SUITE A
RICHMOND, CA
ZIP 94805
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Facility Phone Number: 510 236-8861

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1205135340

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2029742
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RICHMOND DIALYSIS
Street	4200 MACDONALD AVENUE, SUITE A
City	RICHMOND
State	CA
ZIP	94805
Phone	510 236-8861
CertificateType	4
CertificateEffectiveDate	9/14/2023
CertificateExpirationDate	9/13/2025
FacilityType	Waiver

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