05D0952177 CLIA NUMBER - UCSD STUDENT-RUN FREE CLINIC PROJECT

Laboratory Demographics

CLIA Number: 05D0952177

Facility Name: UCSD STUDENT-RUN FREE CLINIC PROJECT

Facility Address:
1561 THOMAS ST
SAN DIEGO, CA
ZIP 92109
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Facility Phone Number: 858 534-6160

Facility Type: Other - FREE CLINIC PROJECT

Certificate Type: Waiver

NPI Number: 1578965471

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0952177
LAB Type	Other - FREE CLINIC PROJECT
Facility Name	UCSD STUDENT-RUN FREE CLINIC PROJECT
Street	1561 THOMAS ST
City	SAN DIEGO
State	CA
ZIP	92109
Phone	858 534-6160
CertificateType	4
CertificateEffectiveDate	5/10/2023
CertificateExpirationDate	5/9/2025
FacilityType	Waiver

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