05D2301600 CLIA NUMBER - BROCKTON ENDOSCOPY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2301600
  • Facility Name: BROCKTON ENDOSCOPY SURGERY CENTER
  • Facility Address: 6958 BROCKTON AVE STE 100
    RIVERSIDE, CA
    ZIP 92506
  • Facility Phone: 951 788-4400
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SHEN HUAFENG
  • NPI Number: 1447472659
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2301600
LAB Type Ambulatory Surgery Center
Facility Name BROCKTON ENDOSCOPY SURGERY CENTER
Street 6958 BROCKTON AVE STE 100
City RIVERSIDE
State CA
ZIP 92506
Phone 951 788-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2024
Certificate Expiration Date 3/27/2026
Facility Type Ambulatory Surgery Center
Lab Director SHEN HUAFENG

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This page was last updated on: 9/29/2025