05D2071493 CLIA NUMBER - CENTRELAKE IMAGING AND ONCOLOGY

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Laboratory Demographics

CLIA Number: 05D2071493

Facility Name: CENTRELAKE IMAGING AND ONCOLOGY

Facility Address:
1700 W WEST COVINA PKWY
WEST COVINA, CA
ZIP 91790
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Facility Phone Number: 626 773-7718

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1760721112

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2071493
LAB Type	Ambulatory Surgery Center
Facility Name	CENTRELAKE IMAGING AND ONCOLOGY
Street	1700 W WEST COVINA PKWY
City	WEST COVINA
State	CA
ZIP	91790
Phone	626 773-7718
CertificateType	4
CertificateEffectiveDate	1/13/2024
CertificateExpirationDate	1/12/2026
FacilityType	Waiver

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