05D0871064 CLIA NUMBER - SAN MATEO MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D0871064

Facility Name: SAN MATEO MEDICAL CLINIC

Facility Address:
4055 WHITTIER BLVD
LOS ANGELES, CA
ZIP 90023
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Facility Phone Number: 323 780-4000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1881795003

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0871064
LAB Type	Physician Office
Facility Name	SAN MATEO MEDICAL CLINIC
Street	4055 WHITTIER BLVD
City	LOS ANGELES
State	CA
ZIP	90023
Phone	323 780-4000
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024