05D0920193 CLIA NUMBER - CLINICA MEDICA SAN MIGUEL

Laboratory Demographics

  • CLIA Code: 05D0920193
  • Facility Name: CLINICA MEDICA SAN MIGUEL
  • Facility Address: 825 N PARK AVE
    POMONA, CA
    ZIP 91768
  • Facility Phone: 909 622-9988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MAHFOUZ M. MICHAEL
  • NPI Number: 1609095660
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0920193
LAB Type Physician Office
Facility Name CLINICA MEDICA SAN MIGUEL
Street 825 N PARK AVE
City POMONA
State CA
ZIP 91768
Phone 909 622-9988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Physician Office
Lab Director DR. MAHFOUZ M. MICHAEL

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