05D2265819 CLIA NUMBER - CANCER CENTER IMAGING DBA IMAGING CENTER OF IRVINE

Laboratory Demographics

CLIA Number: 05D2265819

Facility Name: CANCER CENTER IMAGING DBA IMAGING CENTER OF IRVINE

Facility Address:
16100 SAND CANYON AVE STE 130
IRVINE, CA
ZIP 92618
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Facility Phone Number: 949 502-3475

Facility Type: Other - DIAG IMAGINING FACILITY

Certificate Type: Waiver

NPI Number: 1275838336

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2265819
LAB Type	Other - DIAG IMAGINING FACILITY
Facility Name	CANCER CENTER IMAGING DBA IMAGING CENTER OF IRVINE
Street	16100 SAND CANYON AVE STE 130
City	IRVINE
State	CA
ZIP	92618
Phone	949 502-3475
CertificateType	4
CertificateEffectiveDate	8/2/2022
CertificateExpirationDate	8/1/2024
FacilityType	Waiver

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