05D2140151 CLIA NUMBER - PAVILION SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D2140151
  • Facility Name: PAVILION SURGERY CENTER, LLC
  • Facility Address: 1140 WEST LA VETA AVE
    ORANGE, CA
    ZIP 92868
  • Facility Phone: 951 432-6049
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: LISA KOHORN, MD
  • NPI Number: 1356878052
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2140151
LAB Type Ambulatory Surgery Center
Facility Name PAVILION SURGERY CENTER, LLC
Street 1140 WEST LA VETA AVE
City ORANGE
State CA
ZIP 92868
Phone 951 432-6049
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Ambulatory Surgery Center
Lab Director LISA KOHORN, MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025