05D0720479 CLIA NUMBER - JORGE R LOPEZ MD

Laboratory Demographics

  • CLIA Code: 05D0720479
  • Facility Name: JORGE R LOPEZ MD
  • Facility Address: 1168 N SAN GABRIEL BLVD B
    ROSEMEAD, CA
    ZIP 91770
  • Facility Phone: 626 288-4741
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JORGE R. LOPEZ MD
  • NPI Number: 1528018504
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0720479
LAB Type Physician Office
Facility Name JORGE R LOPEZ MD
Street 1168 N SAN GABRIEL BLVD B
City ROSEMEAD
State CA
ZIP 91770
Phone 626 288-4741
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 JORGE R. LOPEZ MD

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