05D0579910 CLIA NUMBER - ST JOSEPH HERITAGE HEALTHCARE

Laboratory Demographics

  • CLIA Code: 05D0579910
  • Facility Name: ST JOSEPH HERITAGE HEALTHCARE
  • Facility Address: 1010 W LA VETA AVE STE 20
    ORANGE, CA
    ZIP 92868
  • Facility Phone: 714 835-1800
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MADHAVI MUMMANENI MD
  • NPI Number: 1801443510
  • Taxonomy: 207RH0003X - Internal Medicine

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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
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/28/2021
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director MADHAVI MUMMANENI MD

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