05D2187291 CLIA NUMBER - PAIN CENTER-SAN DIEGO PC, THE

Laboratory Demographics

CLIA Number: 05D2187291

Facility Name: PAIN CENTER-SAN DIEGO PC, THE

Facility Address:
4033 3RD AVE STE 430
SAN DIEGO, CA
ZIP 92103
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Facility Phone Number: 619 578-3740

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1538710611

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D2187291
LAB Type	Physician Office
Facility Name	PAIN CENTER-SAN DIEGO PC, THE
Street	4033 3RD AVE STE 430
City	SAN DIEGO
State	CA
ZIP	92103
Phone	619 578-3740
CertificateType	4
CertificateEffectiveDate	6/29/2022
CertificateExpirationDate	6/28/2024
FacilityType	Waiver

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