05D0581820 CLIA NUMBER - MEMORIALCARE MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0581820

Facility Name: MEMORIALCARE MEDICAL GROUP

Facility Address:
4050 BARRANCA PKWY, SUITE 200
IRVINE, CA
ZIP 92604
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Facility Phone Number: 949 551-1090

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1215079298

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	05D0581820
LAB Type	Physician Office
Facility Name	MEMORIALCARE MEDICAL GROUP
Street	4050 BARRANCA PKWY, SUITE 200
City	IRVINE
State	CA
ZIP	92604
Phone	949 551-1090
CertificateType	3
CertificateEffectiveDate	1/1/2024
CertificateExpirationDate	12/31/2025
FacilityType	PPMP

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