05D0959786 CLIA NUMBER - GARDEN GROVE MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0959786

Facility Name: GARDEN GROVE MEDICAL GROUP

Facility Address:
9896 GARDEN GROVE BLVD
GARDEN GROVE, CA
ZIP 92844
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Facility Phone Number: 714 636-3032

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972781458

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0959786
LAB Type	Physician Office
Facility Name	GARDEN GROVE MEDICAL GROUP
Street	9896 GARDEN GROVE BLVD
City	GARDEN GROVE
State	CA
ZIP	92844
Phone	714 636-3032
CertificateType	4
CertificateEffectiveDate	8/14/2022
CertificateExpirationDate	8/13/2024
FacilityType	Waiver

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