05D2120302 CLIA NUMBER - LA JOLLA COSMETIC LASER AND SURGERY CENTER

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Laboratory Demographics

CLIA Number: 05D2120302

Facility Name: LA JOLLA COSMETIC LASER AND SURGERY CENTER

Facility Address:
7720 FAY AVE
LA JOLLA, CA
ZIP 92037
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Facility Phone Number: 858 454-2700

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1588966238

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D2120302
LAB Type	Ambulatory Surgery Center
Facility Name	LA JOLLA COSMETIC LASER AND SURGERY CENTER
Street	7720 FAY AVE
City	LA JOLLA
State	CA
ZIP	92037
Phone	858 454-2700
CertificateType	4
CertificateEffectiveDate	10/13/2022
CertificateExpirationDate	10/12/2024
FacilityType	Waiver

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