05D0710870 CLIA NUMBER - SAMUEL A BOLIVAR, MD INC

Laboratory Demographics

  • CLIA Code: 05D0710870
  • Facility Name: SAMUEL A BOLIVAR, MD INC
  • Facility Address: 555 WEST D STREET STE 130
    SAN BERNARDINO, CA
    ZIP 92410
  • Facility Phone: 909 888-8154
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMUEL A. BOLIVAR MD
  • NPI Number: 1144251067
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0710870
LAB Type Physician Office
Facility Name SAMUEL A BOLIVAR, MD INC
Street 555 WEST D STREET STE 130
City SAN BERNARDINO
State CA
ZIP 92410
Phone 909 888-8154
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 SAMUEL A. BOLIVAR MD

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