05D0871400 CLIA NUMBER - ST JOHN COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0871400

Facility Name: ST JOHN COMMUNITY HEALTH CENTER

Facility Address:
2112 S GAREY AVE STE C
POMONA, CA
ZIP 91766
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Facility Phone Number: 909 464-0520

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962069393

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0871400
LAB Type	Physician Office
Facility Name	ST JOHN COMMUNITY HEALTH CENTER
Street	2112 S GAREY AVE STE C
City	POMONA
State	CA
ZIP	91766
Phone	909 464-0520
CertificateType	4
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Waiver

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