05D2274269 CLIA NUMBER - SILVERLAKE VIRGIL SURGERY CENTER INC

Laboratory Demographics

CLIA Number: 05D2274269

Facility Name: SILVERLAKE VIRGIL SURGERY CENTER INC

Facility Address:
3367 W 1ST ST STE 204
LOS ANGELES, CA
ZIP 90004
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Facility Phone Number: 213 315-5200

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1902457963

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2274269
LAB Type	Ambulatory Surgery Center
Facility Name	SILVERLAKE VIRGIL SURGERY CENTER INC
Street	3367 W 1ST ST STE 204
City	LOS ANGELES
State	CA
ZIP	90004
Phone	213 315-5200
CertificateType	4
CertificateEffectiveDate	12/29/2022
CertificateExpirationDate	12/28/2024
FacilityType	Waiver

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