05D0930536 CLIA NUMBER - SHINE MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D0930536
  • Facility Name: SHINE MEDICAL GROUP INC
  • Facility Address: 1901 W BADILLO STREET
    WEST COVINA, CA
    ZIP 91790
  • Facility Phone: 818 962-5625
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT A. TRACY DO
  • NPI Number: 1639233166
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0930536
LAB Type Physician Office
Facility Name SHINE MEDICAL GROUP INC
Street 1901 W BADILLO STREET
City WEST COVINA
State CA
ZIP 91790
Phone 818 962-5625
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2025
Certificate Expiration Date 7/14/2027
Facility Type Physician Office
Lab Director ROBERT A. TRACY DO

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