05D0896974 CLIA NUMBER - SAMUEL A BOLIVAR, MD INC

Laboratory Demographics

  • CLIA Code: 05D0896974
  • Facility Name: SAMUEL A BOLIVAR, MD INC
  • Facility Address: 10600 MAGNOLIA AVE STE J
    RIVERSIDE, CA
    ZIP 92505
  • Facility Phone: 951 352-3417
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMUEL A. BOLIVAR MD
  • NPI Number: 1447518733
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D0896974
LAB Type Physician Office
Facility Name SAMUEL A BOLIVAR, MD INC
Street 10600 MAGNOLIA AVE STE J
City RIVERSIDE
State CA
ZIP 92505
Phone 951 352-3417
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Physician Office
Lab Director SAMUEL A. BOLIVAR MD

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