05D0060416 CLIA NUMBER - STUDENT HEALTH SERVICES LAB CAL STATE POLY UNIVERSITY POMONA

Laboratory Demographics

CLIA Number: 05D0060416

Facility Name: STUDENT HEALTH SERVICES LAB CAL STATE POLY UNIVERSITY POMONA

Facility Address:
3801 W TEMPLE AVE, BLDG 46
POMONA, CA
ZIP 91768
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Facility Phone Number: 909 869-3218

Facility Type: School/Student Health Service

Certificate Type: Accreditation

NPI Number: 1932396512

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0060416
LAB Type	School/Student Health Service
Facility Name	STUDENT HEALTH SERVICES LAB CAL STATE POLY UNIVERSITY POMONA
Street	3801 W TEMPLE AVE, BLDG 46
City	POMONA
State	CA
ZIP	91768
Phone	909 869-3218
CertificateType	1
CertificateEffectiveDate	10/1/2023
CertificateExpirationDate	9/30/2025
FacilityType	Accreditation

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