05D0934496 CLIA NUMBER - KAISER FOUNDATION HOSPITAL FONTANA/ONTARIO HOME HEALTH

Laboratory Demographics

  • CLIA Code: 05D0934496
  • Facility Name: KAISER FOUNDATION HOSPITAL FONTANA/ONTARIO HOME HEALTH
  • Facility Address: 17284 SLOVER AVE, STE 105
    FONTANA, CA
    ZIP 92337
  • Facility Phone: 909 609-3883
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: YIQIONG MAO
  • NPI Number: 1053466961
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D0934496
LAB Type Home Health Agency
Facility Name KAISER FOUNDATION HOSPITAL FONTANA/ONTARIO HOME HEALTH
Street 17284 SLOVER AVE, STE 105
City FONTANA
State CA
ZIP 92337
Phone 909 609-3883
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2023
Certificate Expiration Date 10/6/2025
Facility Type Home Health Agency
Lab Director YIQIONG MAO

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