05D2166396 CLIA NUMBER - SOCAL SURGICAL SPECIALTIES, LLC

Laboratory Demographics

CLIA Number: 05D2166396

Facility Name: SOCAL SURGICAL SPECIALTIES, LLC

Facility Address:
900 WILSHIRE BOULEVARD, SUITE 300
SANTA MONICA, CA
ZIP 90401
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Facility Phone Number: 310 315-9211

Facility Type: Other - SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1538640958

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2166396
LAB Type	Other - SURGERY CENTER
Facility Name	SOCAL SURGICAL SPECIALTIES, LLC
Street	900 WILSHIRE BOULEVARD, SUITE 300
City	SANTA MONICA
State	CA
ZIP	90401
Phone	310 315-9211
CertificateType	4
CertificateEffectiveDate	5/16/2023
CertificateExpirationDate	5/15/2025
FacilityType	Waiver

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