05D2155301 CLIA NUMBER - ASI SURGERY CENTER, INC

Laboratory Demographics

CLIA Number: 05D2155301

Facility Name: ASI SURGERY CENTER, INC

Facility Address:
4836 VAN NUYS BLVD. SUITE A
SHERMAN OAKS, CA
ZIP 91403
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Facility Phone Number: 818 907-7546

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1215286083

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2155301
LAB Type	Ambulatory Surgery Center
Facility Name	ASI SURGERY CENTER, INC
Street	4836 VAN NUYS BLVD. SUITE A
City	SHERMAN OAKS
State	CA
ZIP	91403
Phone	818 907-7546
CertificateType	4
CertificateEffectiveDate	9/26/2022
CertificateExpirationDate	9/25/2024
FacilityType	Waiver

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