05D0867498 CLIA NUMBER - MT SAN ANTONIO COLLEGE

Laboratory Demographics

  • CLIA Code: 05D0867498
  • Facility Name: MT SAN ANTONIO COLLEGE
  • Facility Address: 1100 NORTH GRAND AVE, BLDG 67B, 1ST FLOOR
    WALNUT, CA
    ZIP 91789
  • Facility Phone: 909 274-5968
  • Facility Type: School/Student Health Service
  • Facility Type: Microscopy
  • Lab Director: ANN G. WALKER
  • NPI Number: 1962687269
  • Taxonomy: 261QS1000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0867498
LAB Type School/Student Health Service
Facility Name MT SAN ANTONIO COLLEGE
Street 1100 NORTH GRAND AVE, BLDG 67B, 1ST FLOOR
City WALNUT
State CA
ZIP 91789
Phone 909 274-5968
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 School/Student Health Service
Lab Director ANN G. WALKER

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