05D0579825 CLIA NUMBER - TUSTIN IRVINE INTERNAL MED GROUP, INC

Laboratory Demographics

  • CLIA Code: 05D0579825
  • Facility Name: TUSTIN IRVINE INTERNAL MED GROUP, INC
  • Facility Address: 15000 KENSINGTON PARK DRIVE SUITE 360
    TUSTIN, CA
    ZIP 92782
  • Facility Phone: 714 838-5610
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIO S. FICAROLA MD
  • NPI Number: 1689633125
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0579825
LAB Type Physician Office
Facility Name TUSTIN IRVINE INTERNAL MED GROUP, INC
Street 15000 KENSINGTON PARK DRIVE SUITE 360
City TUSTIN
State CA
ZIP 92782
Phone 714 838-5610
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Physician Office
Lab Director MARIO S. FICAROLA MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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