65D2241309 CLIA NUMBER - ISLAND SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 65D2241309
  • Facility Name: ISLAND SURGICAL CENTER
  • Facility Address: 171 FARENHOLT AVE
    TAMUNING, GU
    ZIP 96913
  • Facility Phone: 671 646-0443
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RICARDO B. EUSEBIO
  • NPI Number: 1972033538
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 65D2241309
LAB Type Physician Office
Facility Name ISLAND SURGICAL CENTER
Street 171 FARENHOLT AVE
City TAMUNING
State GU
ZIP 96913
Phone 671 646-0443
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Physician Office
Lab Director DR. RICARDO B. EUSEBIO

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