05D0891062 CLIA NUMBER - BOLSA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0891062
  • Facility Name: BOLSA MEDICAL GROUP
  • Facility Address: 10362 BOLSA AVENUE
    WESTMINSTER, CA
    ZIP 92683
  • Facility Phone: 714 531-2091
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CO PHAM, MD
  • NPI Number: 1720423833
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 05D0891062
LAB Type Practitioner Other
Facility Name BOLSA MEDICAL GROUP
Street 10362 BOLSA AVENUE
City WESTMINSTER
State CA
ZIP 92683
Phone 714 531-2091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2024
Certificate Expiration Date 5/1/2026
Facility Type Practitioner Other
Lab Director CO PHAM, MD

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