05D0574214 CLIA NUMBER - SOUTHERN CALIFORNIA PRIMARY CARE

Laboratory Demographics

CLIA Number: 05D0574214

Facility Name: SOUTHERN CALIFORNIA PRIMARY CARE

Facility Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
ZIP 92532
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Facility Phone Number: (951) 244-3500

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1710242474

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	05D0574214
LAB Type	PHYSICIAN OFFICE
Facility Name	SOUTHERN CALIFORNIA PRIMARY CARE
Street	31581 CANYON ESTATES DR
City	LAKE ELSINORE
State	CA
ZIP	92532
Phone	(951) 244-3500

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This page was last updated on: 5/11/2023