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05D0988761 CLIA NUMBER - FOOTHILL COMMUNITY MEDICAL CORP/SAN RAFAEL COMMUNITY MEDICAL CLINIC INC

Laboratory Demographics

CLIA Number: 05D0988761

Facility Name: FOOTHILL COMMUNITY MEDICAL CORP/SAN RAFAEL COMMUNITY MEDICAL CLINIC INC

Facility Address:
647 E ARROW HWY
AZUSA, CA
ZIP 91702
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Facility Phone Number: 626 858-5199

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1881811404

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 05D0988761
LAB Type Physician Office
Facility Name FOOTHILL COMMUNITY MEDICAL CORP/SAN RAFAEL COMMUNITY MEDICAL CLINIC INC
Street 647 E ARROW HWY
City AZUSA
State CA
ZIP 91702
Phone 626 858-5199
CertificateType 4
CertificateEffectiveDate 7/9/2023
CertificateExpirationDate 7/8/2025
FacilityType Waiver

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