05D0700619 CLIA NUMBER - BASELINE MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D0700619
  • Facility Name: BASELINE MEDICAL CLINIC
  • Facility Address: 330 N D ST STE 300
    SAN BERNARDINO, CA
    ZIP 92401
  • Facility Phone: 909 888-6602
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HOANG-CHUONG N. VU, MD.
  • NPI Number: 1891862553
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0700619
LAB Type Physician Office
Facility Name BASELINE MEDICAL CLINIC
Street 330 N D ST STE 300
City SAN BERNARDINO
State CA
ZIP 92401
Phone 909 888-6602
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director HOANG-CHUONG N. VU, MD.

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