05D0580056 CLIA NUMBER - CHARLES JACKSON MD

Laboratory Demographics

CLIA Number: 05D0580056

Facility Name: CHARLES JACKSON MD

Facility Address:
17122 BEACH BLVD, SUITE 102
HUNTINGTON BEACH, CA
ZIP 92647
17122 BEACH BLVD, SUITE 102
HUNTINGTON BEACH, CA
ZIP 92647
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Facility Phone Number: (714) 847-6545

Facility Type: PHYSICIAN OFFICE

Certificate Type: Microscopy

NPI Number: 1083662845

Taxonomy: 208D00000X - General Practice

CLIA Record

Field Name Field Value
CLIA Number 05D0580056
LAB Type PHYSICIAN OFFICE
Facility Name CHARLES JACKSON MD
Street 17122 BEACH BLVD, SUITE 102
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone (714) 847-6545
CLIA Number 05D0580056
LAB Type PHYSICIAN OFFICE
Facility Name CHARLES JACKSON MD
Street 17122 BEACH BLVD, SUITE 102
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone (714) 847-6545

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This page was last updated on: 1/7/2022