05D2196617 CLIA NUMBER - ADVANCED RETINA ASSOCIATES MEDICAL GROUP INC

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Laboratory Demographics

CLIA Number: 05D2196617

Facility Name: ADVANCED RETINA ASSOCIATES MEDICAL GROUP INC

Facility Address:
351 S B ST
OXNARD, CA
ZIP 93030
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Facility Phone Number: 805 240-1650

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1740655232

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2196617
LAB Type	Practitioner Other
Facility Name	ADVANCED RETINA ASSOCIATES MEDICAL GROUP INC
Street	351 S B ST
City	OXNARD
State	CA
ZIP	93030
Phone	805 240-1650
CertificateType	4
CertificateEffectiveDate	10/19/2022
CertificateExpirationDate	10/18/2024
FacilityType	Waiver

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