05D0574214 CLIA NUMBER - SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC

Laboratory Demographics

  • CLIA Code: 05D0574214
  • Facility Name: SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
  • Facility Address: 31581 CANYON ESTATES DR
    LAKE ELSINORE, CA
    ZIP 92532
  • Facility Phone: 951 244-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD R. DAMESH MD
  • NPI Number: 1710242474
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 05D0574214
LAB Type Physician Office
Facility Name SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
Street 31581 CANYON ESTATES DR
City LAKE ELSINORE
State CA
ZIP 92532
Phone 951 244-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MOHAMMAD R. DAMESH MD

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This page was last updated on: 6/4/2025