05D2118543 CLIA NUMBER - RIDGE SURGICAL CENTER, LLC

Laboratory Demographics

CLIA Number: 05D2118543

Facility Name: RIDGE SURGICAL CENTER, LLC

Facility Address:
30300 AGOURA RD STE B 160
AGOURA HILLS, CA
ZIP 91301
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Facility Phone Number: 818 889-1858

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1194175117

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2118543
LAB Type	Ambulatory Surgery Center
Facility Name	RIDGE SURGICAL CENTER, LLC
Street	30300 AGOURA RD STE B 160
City	AGOURA HILLS
State	CA
ZIP	91301
Phone	818 889-1858
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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