05D0573164 CLIA NUMBER - BEAR MOUNTAIN FAMILY PRACTICE PROF CORP DBA BEAR MOUNTAIN FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 05D0573164
  • Facility Name: BEAR MOUNTAIN FAMILY PRACTICE PROF CORP DBA BEAR MOUNTAIN FAMILY PRACTICE
  • Facility Address: 41933 BIG BEAR BLVD
    BIG BEAR LAKE, CA
    ZIP 92315
  • Facility Phone: 909 866-5868
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER H. FAGAN MD
  • NPI Number: 1720107592
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0573164
LAB Type Physician Office
Facility Name BEAR MOUNTAIN FAMILY PRACTICE PROF CORP DBA BEAR MOUNTAIN FAMILY PRACTICE
Street 41933 BIG BEAR BLVD
City BIG BEAR LAKE
State CA
ZIP 92315
Phone 909 866-5868
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2024
Certificate Expiration Date 6/21/2026
Facility Type Physician Office
Lab Director CHRISTOPHER H. FAGAN MD

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