05D2126644 CLIA NUMBER - THAKER UROLOGICAL CENTER, INC.

Laboratory Demographics

CLIA Number: 05D2126644

Facility Name: THAKER UROLOGICAL CENTER, INC.

Facility Address:
4500 BRACKTON AVE
RIVERSIDE, CA
ZIP 92501
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Facility Phone Number: 951 683-5800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396108940

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	05D2126644
LAB Type	Physician Office
Facility Name	THAKER UROLOGICAL CENTER, INC.
Street	4500 BRACKTON AVE
City	RIVERSIDE
State	CA
ZIP	92501
Phone	951 683-5800
CertificateType	4
CertificateEffectiveDate	3/2/2023
CertificateExpirationDate	3/1/2025
FacilityType	Waiver

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