05D0887594 CLIA NUMBER - INLAND CENTER MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0887594

Facility Name: INLAND CENTER MEDICAL GROUP

Facility Address:
9220 HAVEN AVE 210
RANCHO CUCAMONGA, CA
ZIP 91730
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Facility Phone Number: 909 989-7551

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1487613766

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0887594
LAB Type	Independent
Facility Name	INLAND CENTER MEDICAL GROUP
Street	9220 HAVEN AVE 210
City	RANCHO CUCAMONGA
State	CA
ZIP	91730
Phone	909 989-7551
CertificateType	4
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	Waiver

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