05D0936983 CLIA NUMBER - MODERN CONCEPTS MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0936983
  • Facility Name: MODERN CONCEPTS MEDICAL GROUP
  • Facility Address: 50 BELLFONTAINE STREET, SUITE 404
    PASADENA, CA
    ZIP 91105
  • Facility Phone: 626 793-1931
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GUSTAVO CALLEROS MD
  • NPI Number: 1194930420
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0936983
LAB Type Physician Office
Facility Name MODERN CONCEPTS MEDICAL GROUP
Street 50 BELLFONTAINE STREET, SUITE 404
City PASADENA
State CA
ZIP 91105
Phone 626 793-1931
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 8/30/2024
Certificate Expiration Date 8/29/2026
Facility Type Physician Office
Lab Director GUSTAVO CALLEROS MD

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