05D2220423 CLIA NUMBER - PALM VALLEY AMBULATORY SURGICAL CENTER

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Laboratory Demographics

CLIA Number: 05D2220423

Facility Name: PALM VALLEY AMBULATORY SURGICAL CENTER

Facility Address:
72650 FRED WARING DR SUITE 103
PALM DESERT, CA
ZIP 92260
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Facility Phone Number: 760 810-7587

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1316440811

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2220423
LAB Type	Ambulatory Surgery Center
Facility Name	PALM VALLEY AMBULATORY SURGICAL CENTER
Street	72650 FRED WARING DR SUITE 103
City	PALM DESERT
State	CA
ZIP	92260
Phone	760 810-7587
CertificateType	4
CertificateEffectiveDate	4/12/2023
CertificateExpirationDate	4/11/2025
FacilityType	Waiver

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