05D0955422 CLIA NUMBER - BERTHA A GONZALEZ DO INC

Laboratory Demographics

  • CLIA Code: 05D0955422
  • Facility Name: BERTHA A GONZALEZ DO INC
  • Facility Address: 3106 W BEVERLY BOULEVARD
    MONTEBELLO, CA
    ZIP 90640
  • Facility Phone: 323 728-1274
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BERTHA A. GONZALEZ DO
  • NPI Number: 1841477767
  • Taxonomy: 302F00000X - Exclusive Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 05D0955422
LAB Type Physician Office
Facility Name BERTHA A GONZALEZ DO INC
Street 3106 W BEVERLY BOULEVARD
City MONTEBELLO
State CA
ZIP 90640
Phone 323 728-1274
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Physician Office
Lab Director BERTHA A. GONZALEZ DO

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