05D2046385 CLIA NUMBER - CORONA SUMMIT SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 05D2046385
  • Facility Name: CORONA SUMMIT SURGICAL CENTER
  • Facility Address: 2370 ANSELMO DRIVE
    CORONA, CA
    ZIP 92879
  • Facility Phone: 909 896-5245
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RICHARD SHEPARD
  • NPI Number: 1073986527
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2046385
LAB Type Ambulatory Surgery Center
Facility Name CORONA SUMMIT SURGICAL CENTER
Street 2370 ANSELMO DRIVE
City CORONA
State CA
ZIP 92879
Phone 909 896-5245
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Ambulatory Surgery Center
Lab Director RICHARD SHEPARD

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This page was last updated on: 9/29/2025