05D2157594 CLIA NUMBER - GREAT LIFE SURGERY CENTER INC

Laboratory Demographics

CLIA Number: 05D2157594

Facility Name: GREAT LIFE SURGERY CENTER INC

Facility Address:
3445 PACIFIC COAST HWY SUITE 240
TORRANCE, CA
ZIP 90505
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Facility Phone Number: 310 326-9080

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1265895858

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2157594
LAB Type	Ambulatory Surgery Center
Facility Name	GREAT LIFE SURGERY CENTER INC
Street	3445 PACIFIC COAST HWY SUITE 240
City	TORRANCE
State	CA
ZIP	90505
Phone	310 326-9080
CertificateType	4
CertificateEffectiveDate	3/20/2023
CertificateExpirationDate	3/19/2025
FacilityType	Waiver

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