05D0929612 CLIA NUMBER - FILLMORE MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 05D0929612
  • Facility Name: FILLMORE MEDICAL CENTER
  • Facility Address: 852 VENTURA STREET
    FILLMORE, CA
    ZIP 93015
  • Facility Phone: 805 524-2672
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: RAYMOND MENCHACA MD
  • NPI Number: 1912997016
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0929612
LAB Type Community Clinic
Facility Name FILLMORE MEDICAL CENTER
Street 852 VENTURA STREET
City FILLMORE
State CA
ZIP 93015
Phone 805 524-2672
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Community Clinic
Lab Director RAYMOND MENCHACA MD

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