05D0666584 CLIA NUMBER - PACOIMA HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0666584

Facility Name: PACOIMA HEALTH CENTER

Facility Address:
12756 VAN NUYS BOULEVARD
PACOIMA, CA
ZIP 91331
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Facility Phone Number: 818 896-0531

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1114928595

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0666584
LAB Type	Community Clinic
Facility Name	PACOIMA HEALTH CENTER
Street	12756 VAN NUYS BOULEVARD
City	PACOIMA
State	CA
ZIP	91331
Phone	818 896-0531
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