05D0899364 CLIA NUMBER - MIKIO TACHIBANA MD

Laboratory Demographics

  • CLIA Code: 05D0899364
  • Facility Name: MIKIO TACHIBANA MD
  • Facility Address: 11100 WARNER AVENUE SUITE 154
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 966-2800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIKIO TACHIBANA
  • NPI Number: 1598721227
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0899364
LAB Type Physician Office
Facility Name MIKIO TACHIBANA MD
Street 11100 WARNER AVENUE SUITE 154
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 966-2800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Physician Office
Lab Director MIKIO TACHIBANA

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