05D0948701 CLIA NUMBER - MARIO CARCAMO MD

Laboratory Demographics

  • CLIA Code: 05D0948701
  • Facility Name: MARIO CARCAMO MD
  • Facility Address: 4440 BROCKTON AVE #420
    RIVERSIDE, CA
    ZIP 92501
  • Facility Phone: 951 684-8020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIO CARCAMO MD
  • NPI Number: 1518916725
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0948701
LAB Type Physician Office
Facility Name MARIO CARCAMO MD
Street 4440 BROCKTON AVE #420
City RIVERSIDE
State CA
ZIP 92501
Phone 951 684-8020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2024
Certificate Expiration Date 7/15/2026
Facility Type Physician Office
Lab Director MARIO CARCAMO MD

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