05D0589791 CLIA NUMBER - ILDEFONSO CRUZ MD

Laboratory Demographics

CLIA Number: 05D0589791

Facility Name: ILDEFONSO CRUZ MD

Facility Address:
1646 E HERNDON #102
FRESNO, CA
ZIP 93720
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Facility Phone Number: 559 449-7300

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1275689085

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D0589791
LAB Type	Physician Office
Facility Name	ILDEFONSO CRUZ MD
Street	1646 E HERNDON #102
City	FRESNO
State	CA
ZIP	93720
Phone	559 449-7300
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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