05D2189029 CLIA NUMBER - SURGERY CENTER OF SAN DIEGO LLC

Laboratory Demographics

CLIA Number: 05D2189029

Facility Name: SURGERY CENTER OF SAN DIEGO LLC

Facility Address:
3434 MIDWAY DRIVE SUITE 1008
SAN DIEGO, CA
ZIP 92110
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Facility Phone Number: 858 432-7899

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1902438112

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2189029
LAB Type	Ambulatory Surgery Center
Facility Name	SURGERY CENTER OF SAN DIEGO LLC
Street	3434 MIDWAY DRIVE SUITE 1008
City	SAN DIEGO
State	CA
ZIP	92110
Phone	858 432-7899
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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