05D2077548 CLIA NUMBER - EXECUTIVE SURGERY CENTER INC

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Laboratory Demographics

CLIA Number: 05D2077548

Facility Name: EXECUTIVE SURGERY CENTER INC

Facility Address:
1320 EL CAPITAN DR STE 100
DANVILLE, CA
ZIP 94526
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Facility Phone Number: 925 866-9300

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1952698078

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2077548
LAB Type	Ambulatory Surgery Center
Facility Name	EXECUTIVE SURGERY CENTER INC
Street	1320 EL CAPITAN DR STE 100
City	DANVILLE
State	CA
ZIP	94526
Phone	925 866-9300
CertificateType	4
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Waiver

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