05D0564080 CLIA NUMBER - PROVIDENCE DIAMOND BAR

Laboratory Demographics

  • CLIA Code: 05D0564080
  • Facility Name: PROVIDENCE DIAMOND BAR
  • Facility Address: 253 S DIAMOND BAR BLVD
    DIAMOND BAR, CA
    ZIP 91765
  • Facility Phone: 909 860-1144
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DOUGLAS STARR
  • NPI Number: 1285890624
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D0564080
LAB Type Physician Office
Facility Name PROVIDENCE DIAMOND BAR
Street 253 S DIAMOND BAR BLVD
City DIAMOND BAR
State CA
ZIP 91765
Phone 909 860-1144
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director DOUGLAS STARR

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