05D2125283 CLIA NUMBER - ADDISON ASC, LLC

Laboratory Demographics

CLIA Number: 05D2125283

Facility Name: ADDISON ASC, LLC

Facility Address:
4955 VAN NUYS BLVD STE 719
SHERMAN OAKS, CA
ZIP 91403
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Facility Phone Number: 808 325-0400

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1467903716

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2125283
LAB Type	Ambulatory Surgery Center
Facility Name	ADDISON ASC, LLC
Street	4955 VAN NUYS BLVD STE 719
City	SHERMAN OAKS
State	CA
ZIP	91403
Phone	808 325-0400
CertificateType	4
CertificateEffectiveDate	2/3/2023
CertificateExpirationDate	2/2/2025
FacilityType	Waiver

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