05D0696539 CLIA NUMBER - SUNSHINE PEDIATRIC MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0696539

Facility Name: SUNSHINE PEDIATRIC MEDICAL GROUP

Facility Address:
160 EAST ARTESIA # 235
POMONA, CA
ZIP 91767
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Facility Phone Number: 909 397-5205

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1033139647

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D0696539
LAB Type	Physician Office
Facility Name	SUNSHINE PEDIATRIC MEDICAL GROUP
Street	160 EAST ARTESIA # 235
City	POMONA
State	CA
ZIP	91767
Phone	909 397-5205
CertificateType	4
CertificateEffectiveDate	6/10/2023
CertificateExpirationDate	6/9/2025
FacilityType	Waiver

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