05D0579395 CLIA NUMBER - OPTUM CARE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0579395
  • Facility Name: OPTUM CARE MEDICAL GROUP
  • Facility Address: 724 S EL CAMINO REAL
    SAN CLEMENTE, CA
    ZIP 92672
  • Facility Phone: 949 923-3250
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: YELENA WOOD
  • NPI Number: 1386724375
  • Taxonomy: 174400000X - Specialist

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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
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 YELENA WOOD

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