05D2077548 CLIA NUMBER - EXECUTIVE SURGERY CENTER INC

Laboratory Demographics

  • CLIA Code: 05D2077548
  • Facility Name: EXECUTIVE SURGERY CENTER INC
  • Facility Address: 1320 EL CAPITAN DR STE 100
    DANVILLE, CA
    ZIP 94526
  • Facility Phone: 925 866-9300
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SALIM SHELBY MD
  • NPI Number: 1952698078
  • Taxonomy: 261QA1903X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Ambulatory Surgery Center
Lab Director SALIM SHELBY MD

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