05D2182096 CLIA NUMBER - US RENAL CARE VICTORVILLE DIALYSIS

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Laboratory Demographics

CLIA Number: 05D2182096

Facility Name: US RENAL CARE VICTORVILLE DIALYSIS

Facility Address:
17125 SILICA DRIVE SUITE 100
VICTORVILLE, CA
ZIP 92395
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Facility Phone Number: 760 904-3570

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073960845

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2182096
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	US RENAL CARE VICTORVILLE DIALYSIS
Street	17125 SILICA DRIVE SUITE 100
City	VICTORVILLE
State	CA
ZIP	92395
Phone	760 904-3570
CertificateType	4
CertificateEffectiveDate	4/15/2024
CertificateExpirationDate	4/14/2026
FacilityType	Waiver

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