05D0723119 CLIA NUMBER - SHELTER ISLAND MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D0723119
  • Facility Name: SHELTER ISLAND MEDICAL GROUP INC
  • Facility Address: 1370 ROSECRANS ST STE A
    SAN DIEGO, CA
    ZIP 92106
  • Facility Phone: 619 223-2668
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD H. CHAMBERS MD
  • NPI Number: 1790886216
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0723119
LAB Type Physician Office
Facility Name SHELTER ISLAND MEDICAL GROUP INC
Street 1370 ROSECRANS ST STE A
City SAN DIEGO
State CA
ZIP 92106
Phone 619 223-2668
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/1/2025
Certificate Expiration Date 12/31/2026
Facility Type Physician Office
Lab Director EDWARD H. CHAMBERS MD

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