05D2162261 CLIA NUMBER - PRIME HEALTHCARE SURGICAL CENTER OF THE VALLEY

Laboratory Demographics

CLIA Number: 05D2162261

Facility Name: PRIME HEALTHCARE SURGICAL CENTER OF THE VALLEY

Facility Address:
19331 BUSINESS CENTER DRIVE, SUITE 102
NORTHRIDGE, CA
ZIP 91324
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Facility Phone Number: 818 709-5555

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407529845

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2162261
LAB Type	Physician Office
Facility Name	PRIME HEALTHCARE SURGICAL CENTER OF THE VALLEY
Street	19331 BUSINESS CENTER DRIVE, SUITE 102
City	NORTHRIDGE
State	CA
ZIP	91324
Phone	818 709-5555
CertificateType	4
CertificateEffectiveDate	2/20/2023
CertificateExpirationDate	2/19/2025
FacilityType	Waiver

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