05D0579910 CLIA NUMBER - ST JOSEPH HERITAGE HEALTHCARE

Laboratory Demographics

CLIA Number: 05D0579910

Facility Name: ST JOSEPH HERITAGE HEALTHCARE

Facility Address:
1010 W LA VETA AVE STE 20
ORANGE, CA
ZIP 92868
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Facility Phone Number: 714 835-1800

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1801443510

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	05D0579910
LAB Type	Physician Office
Facility Name	ST JOSEPH HERITAGE HEALTHCARE
Street	1010 W LA VETA AVE STE 20
City	ORANGE
State	CA
ZIP	92868
Phone	714 835-1800
CertificateType	2
CertificateEffectiveDate	10/28/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024