05D2134892 CLIA NUMBER - BALDWIN PARK DIALYSIS

Laboratory Demographics

CLIA Number: 05D2134892

Facility Name: BALDWIN PARK DIALYSIS

Facility Address:
14101 FRANCISQUITO AVE
BALDWIN PARK, CA
ZIP 91706
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Facility Phone Number: 626 337-1847

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1780136093

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2134892
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BALDWIN PARK DIALYSIS
Street	14101 FRANCISQUITO AVE
City	BALDWIN PARK
State	CA
ZIP	91706
Phone	626 337-1847
CertificateType	4
CertificateEffectiveDate	8/10/2023
CertificateExpirationDate	8/9/2025
FacilityType	Waiver

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