05D2095350 CLIA NUMBER - RIVER'S EDGE SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D2095350

Facility Name: RIVER'S EDGE SURGERY CENTER

Facility Address:
71780 SAN JACINTO DR BLDG D
RANCHO MIRAGE, CA
ZIP 92270
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Facility Phone Number: 760 862-1888

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1811386147

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2095350
LAB Type	Ambulatory Surgery Center
Facility Name	RIVER'S EDGE SURGERY CENTER
Street	71780 SAN JACINTO DR BLDG D
City	RANCHO MIRAGE
State	CA
ZIP	92270
Phone	760 862-1888
CertificateType	4
CertificateEffectiveDate	5/6/2023
CertificateExpirationDate	5/5/2025
FacilityType	Waiver

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