05D0581609 CLIA NUMBER - MEMORIALCARE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0581609
  • Facility Name: MEMORIALCARE MEDICAL GROUP
  • Facility Address: 11420 WARNER AVENUE
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 549-1300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STEPHEN HARMS
  • NPI Number: 1205167350
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0581609
LAB Type Physician Office
Facility Name MEMORIALCARE MEDICAL GROUP
Street 11420 WARNER AVENUE
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 549-1300
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 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director STEPHEN HARMS

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