05D0858164 CLIA NUMBER - FONTANA UNIFIED SCHOOL DIST CHILD HEALTH CLINIC

Laboratory Demographics

CLIA Code: 05D0858164
Facility Name: FONTANA UNIFIED SCHOOL DIST CHILD HEALTH CLINIC
Facility Address: 9680 CITRUS AVE BLDG A-7 COMPREHENSIVE HEALTH CLINIC
FONTANA, CA
ZIP 92335
Facility Phone: 909 357-7600
Facility Type: School/Student Health Service
Facility Type: Microscopy
Lab Director: STACIE CRUZ
NPI Number: 1891885604
Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name	Field Value
CLIA Number	05D0858164
LAB Type	School/Student Health Service
Facility Name	FONTANA UNIFIED SCHOOL DIST CHILD HEALTH CLINIC
Street	9680 CITRUS AVE BLDG A-7 COMPREHENSIVE HEALTH CLINIC
City	FONTANA
State	CA
ZIP	92335
Phone	909 357-7600
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	3/9/2025
Certificate Expiration Date	3/8/2027
Facility Type	School/Student Health Service
Lab Director	STACIE CRUZ

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