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

Laboratory Demographics

  • CLIA Code: 05D0988761
  • Facility Name: FOOTHILL COMMUNITY MEDICAL CORP/SAN RAFAEL COMMUNITY MEDICAL CLINIC INC
  • Facility Address: 647 E ARROW HWY
    AZUSA, CA
    ZIP 91702
  • Facility Phone: 626 858-5199
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAFAEL CARCAMO MD
  • NPI Number: 1881811404
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Physician Office
Lab Director RAFAEL CARCAMO MD

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