05D2107692 CLIA NUMBER - ADVANCE SPINE CARE AND PAIN MANAGEMENT

Laboratory Demographics

CLIA Number: 05D2107692

Facility Name: ADVANCE SPINE CARE AND PAIN MANAGEMENT

Facility Address:
2555 E COLORADO BLVD STE 306
PASADENA, CA
ZIP 91107
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Facility Phone Number: 626 538-8950

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255781357

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	05D2107692
LAB Type	Physician Office
Facility Name	ADVANCE SPINE CARE AND PAIN MANAGEMENT
Street	2555 E COLORADO BLVD STE 306
City	PASADENA
State	CA
ZIP	91107
Phone	626 538-8950
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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