05D2131603 CLIA NUMBER - POMONA DIALYSIS CENTER INC

Laboratory Demographics

CLIA Number: 05D2131603

Facility Name: POMONA DIALYSIS CENTER INC

Facility Address:
255 E BONITA AVE STE 200
POMONA, CA
ZIP 91767
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Facility Phone Number: 909 542-2900

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1982065108

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2131603
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	POMONA DIALYSIS CENTER INC
Street	255 E BONITA AVE STE 200
City	POMONA
State	CA
ZIP	91767
Phone	909 542-2900
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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