05D2110038 CLIA NUMBER - CHINO VASCULAR & SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D2110038

Facility Name: CHINO VASCULAR & SURGERY CENTER

Facility Address:
11760 CENTRAL AVE STE 204
CHINO, CA
ZIP 91710
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Facility Phone Number: 909 464-9877

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1023651445

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2110038
LAB Type	Ambulatory Surgery Center
Facility Name	CHINO VASCULAR & SURGERY CENTER
Street	11760 CENTRAL AVE STE 204
City	CHINO
State	CA
ZIP	91710
Phone	909 464-9877
CertificateType	4
CertificateEffectiveDate	3/8/2024
CertificateExpirationDate	3/7/2026
FacilityType	Waiver

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