05D0867410 CLIA NUMBER - PARK VISTA MORINGSIDE

Laboratory Demographics

  • CLIA Code: 05D0867410
  • Facility Name: PARK VISTA MORINGSIDE
  • Facility Address: 2525 BREA BLVD
    FULLERTON, CA
    ZIP 92835
  • Facility Phone: 714 256-8111
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRUCE S. MUTTER
  • NPI Number: 1972594463
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0867410
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PARK VISTA MORINGSIDE
Street 2525 BREA BLVD
City FULLERTON
State CA
ZIP 92835
Phone 714 256-8111
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 Skilled Nursing Facility/Nursing Facility
Lab Director BRUCE S. MUTTER

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