05D0980156 CLIA NUMBER - CRESENCIA D BANZUELA MD INC

Laboratory Demographics

  • CLIA Code: 05D0980156
  • Facility Name: CRESENCIA D BANZUELA MD INC
  • Facility Address: 260 E ONTARIO AVE #204
    CORONA, CA
    ZIP 92879
  • Facility Phone: 909 272-6595
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CRESENCIA D. BANZUELA MD
  • NPI Number: 1083639710
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0980156
LAB Type Physician Office
Facility Name CRESENCIA D BANZUELA MD INC
Street 260 E ONTARIO AVE #204
City CORONA
State CA
ZIP 92879
Phone 909 272-6595
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Physician Office
Lab Director CRESENCIA D. BANZUELA MD

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This page was last updated on: 6/4/2025