05D0674222 CLIA NUMBER - HAROLD W JACKSON DO RAINCROSS MEDICAL GROUP, INC

Laboratory Demographics

  • CLIA Code: 05D0674222
  • Facility Name: HAROLD W JACKSON DO RAINCROSS MEDICAL GROUP, INC
  • Facility Address: 4646 BROCKTON AVE STE 202
    RIVERSIDE, CA
    ZIP 92506
  • Facility Phone: 951 774-2942
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: HAROLD W. JACKSON
  • NPI Number: 1235126475
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0674222
LAB Type Physician Office
Facility Name HAROLD W JACKSON DO RAINCROSS MEDICAL GROUP, INC
Street 4646 BROCKTON AVE STE 202
City RIVERSIDE
State CA
ZIP 92506
Phone 951 774-2942
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director HAROLD W. JACKSON

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This page was last updated on: 9/29/2025