05D0981384 CLIA NUMBER - FONTANA CLINICA MEDICA FAMILIAR MEDICAL CORP

Laboratory Demographics

CLIA Number: 05D0981384

Facility Name: FONTANA CLINICA MEDICA FAMILIAR MEDICAL CORP

Facility Address:
17695 ARROW BLVD
FONTANA, CA
ZIP 92335
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Facility Phone Number: 909 854-3790

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174621585

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D0981384
LAB Type	Physician Office
Facility Name	FONTANA CLINICA MEDICA FAMILIAR MEDICAL CORP
Street	17695 ARROW BLVD
City	FONTANA
State	CA
ZIP	92335
Phone	909 854-3790
CertificateType	4
CertificateEffectiveDate	6/14/2022
CertificateExpirationDate	6/13/2024
FacilityType	Waiver

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