05D0886201 CLIA NUMBER - LAUREL PARK

Laboratory Demographics

  • CLIA Code: 05D0886201
  • Facility Name: LAUREL PARK
  • Facility Address: 1425 W LAUREL AVE
    POMONA, CA
    ZIP 91768
  • Facility Phone: 909 622-1069
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: RANDY ROSS MD
  • NPI Number: 1639126782
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0886201
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAUREL PARK
Street 1425 W LAUREL AVE
City POMONA
State CA
ZIP 91768
Phone 909 622-1069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director RANDY ROSS MD

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