05D0579395 CLIA NUMBER - OPTUM CARE MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0579395

Facility Name: OPTUM CARE MEDICAL GROUP

Facility Address:
724 S EL CAMINO REAL
SAN CLEMENTE, CA
ZIP 92672
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Facility Phone Number: (949) 923-3250

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1386724375

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D0579395
LAB Type	PHYSICIAN OFFICE
Facility Name	OPTUM CARE MEDICAL GROUP
Street	724 S EL CAMINO REAL
City	SAN CLEMENTE
State	CA
ZIP	92672
Phone	(949) 923-3250

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