05D2293349 CLIA NUMBER - DISC SURGERY CENTER AT MARINA DEL REY

Laboratory Demographics

CLIA Number: 05D2293349

Facility Name: DISC SURGERY CENTER AT MARINA DEL REY

Facility Address:
4553 GLENCOE AVE, SUITE 100
MARINA DEL REY, CA
ZIP 90292
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Facility Phone Number: 310 912-6170

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1154600377

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2293349
LAB Type	Ambulatory Surgery Center
Facility Name	DISC SURGERY CENTER AT MARINA DEL REY
Street	4553 GLENCOE AVE, SUITE 100
City	MARINA DEL REY
State	CA
ZIP	90292
Phone	310 912-6170
CertificateType	4
CertificateEffectiveDate	11/7/2023
CertificateExpirationDate	11/6/2025
FacilityType	Waiver

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