05D0568712 CLIA NUMBER - SAN YSIDRO HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0568712

Facility Name: SAN YSIDRO HEALTH CENTER

Facility Address:
4004 BEYER BLVD
SAN YSIDRO, CA
ZIP 92173
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Facility Phone Number: 619 662-4100

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1174164719

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0568712
LAB Type	Federally Qualified Health Center
Facility Name	SAN YSIDRO HEALTH CENTER
Street	4004 BEYER BLVD
City	SAN YSIDRO
State	CA
ZIP	92173
Phone	619 662-4100
CertificateType	3
CertificateEffectiveDate	8/26/2023
CertificateExpirationDate	8/25/2025
FacilityType	PPMP

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