05D0935377 CLIA NUMBER - PROHEALTH PARTNERS,A MEDICAL GROUP,INC

Laboratory Demographics

  • CLIA Code: 05D0935377
  • Facility Name: PROHEALTH PARTNERS,A MEDICAL GROUP,INC
  • Facility Address: 300 REDONDO AVENUE, SUITE B
    LONG BEACH, CA
    ZIP 90814
  • Facility Phone: 562 433-7496
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLAYTON B. DEJONG MD
  • NPI Number: 1447382411
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0935377
LAB Type Physician Office
Facility Name PROHEALTH PARTNERS,A MEDICAL GROUP,INC
Street 300 REDONDO AVENUE, SUITE B
City LONG BEACH
State CA
ZIP 90814
Phone 562 433-7496
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director CLAYTON B. DEJONG MD

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This page was last updated on: 6/4/2025