05D0857471 CLIA NUMBER - ANTONIO A TAN MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D0857471
  • Facility Name: ANTONIO A TAN MEDICAL CLINIC
  • Facility Address: 12980 FREDERICK STREET, SUITE D
    MORENO VALLEY, CA
    ZIP 92553
  • Facility Phone: 951 485-2744
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANTONIO A. TAN
  • NPI Number: 1134277569
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0857471
LAB Type Physician Office
Facility Name ANTONIO A TAN MEDICAL CLINIC
Street 12980 FREDERICK STREET, SUITE D
City MORENO VALLEY
State CA
ZIP 92553
Phone 951 485-2744
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 ANTONIO A. TAN

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