05D0941891 CLIA NUMBER - ST VINCENT DE PAUL VILLAGE FAMILY HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0941891

Facility Name: ST VINCENT DE PAUL VILLAGE FAMILY HEALTH CENTER

Facility Address:
1501 IMPERIAL AVENUE
SAN DIEGO, CA
ZIP 92101
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Facility Phone Number: 619 233-8500

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1659415131

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0941891
LAB Type	Community Clinic
Facility Name	ST VINCENT DE PAUL VILLAGE FAMILY HEALTH CENTER
Street	1501 IMPERIAL AVENUE
City	SAN DIEGO
State	CA
ZIP	92101
Phone	619 233-8500
CertificateType	3
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024