05D0902391 CLIA NUMBER - SYMONETT FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 05D0902391

Facility Name: SYMONETT FAMILY MEDICAL CENTER

Facility Address:
1035 SOUTH MOUNT VERNON, SUITE F
COLTON, CA
ZIP 92324
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Facility Phone Number: 909 824-1060

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255692372

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0902391
LAB Type	Physician Office
Facility Name	SYMONETT FAMILY MEDICAL CENTER
Street	1035 SOUTH MOUNT VERNON, SUITE F
City	COLTON
State	CA
ZIP	92324
Phone	909 824-1060
CertificateType	4
CertificateEffectiveDate	6/19/2023
CertificateExpirationDate	6/18/2025
FacilityType	Waiver

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