05D0896408 CLIA NUMBER - KEITH MARK GROSS MD INC

Laboratory Demographics

  • CLIA Code: 05D0896408
  • Facility Name: KEITH MARK GROSS MD INC
  • Facility Address: 12550 HESPERIA RD, STE 218
    VICTORVILLE, CA
    ZIP 92395
  • Facility Phone: 760 951-9895
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. KEITH M. GROSS
  • NPI Number: 1871658278
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 05D0896408
LAB Type Physician Office
Facility Name KEITH MARK GROSS MD INC
Street 12550 HESPERIA RD, STE 218
City VICTORVILLE
State CA
ZIP 92395
Phone 760 951-9895
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Physician Office
Lab Director DR. KEITH M. GROSS

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