05D2034100 CLIA NUMBER - BON AIR SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D2034100

Facility Name: BON AIR SURGERY CENTER

Facility Address:
575 SIR FRANCIS DRAKE BLVD STE 3
GREENBRAE, CA
ZIP 94904
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Facility Phone Number: 415 925-1030

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1942585526

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2034100
LAB Type	Ambulatory Surgery Center
Facility Name	BON AIR SURGERY CENTER
Street	575 SIR FRANCIS DRAKE BLVD STE 3
City	GREENBRAE
State	CA
ZIP	94904
Phone	415 925-1030
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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