05D0966931 CLIA NUMBER - MODERN CONCEPTS MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0966931
  • Facility Name: MODERN CONCEPTS MEDICAL GROUP
  • Facility Address: 1217 W WHITTIER BLVD
    MONTEBELLO, CA
    ZIP 90640
  • Facility Phone: 323 728-6070
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RODOLFO A. AREVALO
  • NPI Number: 1386859619
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0966931
LAB Type Physician Office
Facility Name MODERN CONCEPTS MEDICAL GROUP
Street 1217 W WHITTIER BLVD
City MONTEBELLO
State CA
ZIP 90640
Phone 323 728-6070
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Physician Office
Lab Director RODOLFO A. AREVALO

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