05D2151499 CLIA NUMBER - PRIME SURGICAL CENTER OF NEWPORT BEACH

Laboratory Demographics

CLIA Number: 05D2151499

Facility Name: PRIME SURGICAL CENTER OF NEWPORT BEACH

Facility Address:
351 HOSPITAL RD STE 110
GLENDALE, CA
ZIP 91203
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Facility Phone Number: 818 937-9969

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639610348

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2151499
LAB Type	Ambulatory Surgery Center
Facility Name	PRIME SURGICAL CENTER OF NEWPORT BEACH
Street	351 HOSPITAL RD STE 110
City	GLENDALE
State	CA
ZIP	91203
Phone	818 937-9969
CertificateType	4
CertificateEffectiveDate	7/19/2022
CertificateExpirationDate	7/18/2024
FacilityType	Waiver

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