05D0581602 CLIA NUMBER - AMERICAN FAMILY MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D0581602
  • Facility Name: AMERICAN FAMILY MEDICAL GROUP INC
  • Facility Address: 2414 S FAIRVIEW ST STE 112
    SANTA ANA, CA
    ZIP 92704
  • Facility Phone: 714 641-0121
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK N. MONROE
  • NPI Number: 1750410007
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0581602
LAB Type Physician Office
Facility Name AMERICAN FAMILY MEDICAL GROUP INC
Street 2414 S FAIRVIEW ST STE 112
City SANTA ANA
State CA
ZIP 92704
Phone 714 641-0121
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director MARK N. MONROE

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This page was last updated on: 6/4/2025