05D2081158 CLIA NUMBER - COLTON RANCH DIALYSIS

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Laboratory Demographics

CLIA Number: 05D2081158

Facility Name: COLTON RANCH DIALYSIS

Facility Address:
1405 W.VALLEY BOULEVARD STE 100
COLTON, CA
ZIP 92324
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Facility Phone Number: 909 783-7948

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1063838894

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2081158
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	COLTON RANCH DIALYSIS
Street	1405 W.VALLEY BOULEVARD STE 100
City	COLTON
State	CA
ZIP	92324
Phone	909 783-7948
CertificateType	4
CertificateEffectiveDate	7/21/2022
CertificateExpirationDate	7/20/2024
FacilityType	Waiver

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