05D2079922 CLIA NUMBER - RAYMOND RENAISSANCE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2079922
  • Facility Name: RAYMOND RENAISSANCE SURGERY CENTER
  • Facility Address: 125 N RAYMOND AVE, STE 212
    PASADENA, CA
    ZIP 91105
  • Facility Phone: 626 529-3937
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KHALED TAWANSY
  • NPI Number: 1871939082
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2079922
LAB Type Ambulatory Surgery Center
Facility Name RAYMOND RENAISSANCE SURGERY CENTER
Street 125 N RAYMOND AVE, STE 212
City PASADENA
State CA
ZIP 91105
Phone 626 529-3937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/26/2024
Certificate Expiration Date 6/25/2026
Facility Type Ambulatory Surgery Center
Lab Director KHALED TAWANSY

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