05D0966981 CLIA NUMBER - MAYWOOD FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 05D0966981

Facility Name: MAYWOOD FAMILY MEDICAL CENTER

Facility Address:
5920 ATLANTIC BLVD
MAYWOOD, CA
ZIP 90270
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Facility Phone Number: 323 562-2535

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801184841

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D0966981
LAB Type	Physician Office
Facility Name	MAYWOOD FAMILY MEDICAL CENTER
Street	5920 ATLANTIC BLVD
City	MAYWOOD
State	CA
ZIP	90270
Phone	323 562-2535
CertificateType	4
CertificateEffectiveDate	10/29/2023
CertificateExpirationDate	10/28/2025
FacilityType	Waiver

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