05D0876601 CLIA NUMBER - INLAND REGION MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0876601

Facility Name: INLAND REGION MEDICAL GROUP

Facility Address:
9089 BASELINE ROAD, SUITE 100-A
RANCHO CUCAMONGA, CA
ZIP 91730
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Facility Phone Number: 909 625-4846

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1083724850

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D0876601
LAB Type	Physician Office
Facility Name	INLAND REGION MEDICAL GROUP
Street	9089 BASELINE ROAD, SUITE 100-A
City	RANCHO CUCAMONGA
State	CA
ZIP	91730
Phone	909 625-4846
CertificateType	4
CertificateEffectiveDate	9/20/2023
CertificateExpirationDate	9/19/2025
FacilityType	Waiver

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