05D2059512 CLIA NUMBER - RENAISSANCE ASC, LLC

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Laboratory Demographics

CLIA Number: 05D2059512

Facility Name: RENAISSANCE ASC, LLC

Facility Address:
44139 MONTEREY STE B
PALM DESERT, CA
ZIP 92260
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Facility Phone Number: 760 773-4411

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1295072049

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2059512
LAB Type	Ambulatory Surgery Center
Facility Name	RENAISSANCE ASC, LLC
Street	44139 MONTEREY STE B
City	PALM DESERT
State	CA
ZIP	92260
Phone	760 773-4411
CertificateType	4
CertificateEffectiveDate	5/23/2023
CertificateExpirationDate	5/22/2025
FacilityType	Waiver

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