05D2068030 CLIA NUMBER - KINETIX SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D2068030

Facility Name: KINETIX SURGERY CENTER

Facility Address:
5651 SEPULVEDA BLVD STE 101
SHERMAN OAKS, CA
ZIP 91411
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Facility Phone Number: 818 442-9696

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1548609472

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2068030
LAB Type	Ambulatory Surgery Center
Facility Name	KINETIX SURGERY CENTER
Street	5651 SEPULVEDA BLVD STE 101
City	SHERMAN OAKS
State	CA
ZIP	91411
Phone	818 442-9696
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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