05D2292161 CLIA NUMBER - HOSPICE OF SOUTHERN CALIFORNIA

Laboratory Demographics

CLIA Number: 05D2292161

Facility Name: HOSPICE OF SOUTHERN CALIFORNIA

Facility Address:
750 N DIAMOND BAR BLVD SUITE 202
DIAMOND BAR, CA
ZIP 91765
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Facility Phone Number: 909 612-0085

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1972767572

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	05D2292161
LAB Type	Hospice
Facility Name	HOSPICE OF SOUTHERN CALIFORNIA
Street	750 N DIAMOND BAR BLVD SUITE 202
City	DIAMOND BAR
State	CA
ZIP	91765
Phone	909 612-0085
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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