05D0994516 CLIA NUMBER - LA SIERRA CLINICA MEDICA FAMILIAR MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D0994516

Facility Name: LA SIERRA CLINICA MEDICA FAMILIAR MEDICAL CLINIC

Facility Address:
10600 MAGNOLIA AVE STE I
RIVERSIDE, CA
ZIP 92505
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Facility Phone Number: 951 324-8100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669513222

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D0994516
LAB Type	Physician Office
Facility Name	LA SIERRA CLINICA MEDICA FAMILIAR MEDICAL CLINIC
Street	10600 MAGNOLIA AVE STE I
City	RIVERSIDE
State	CA
ZIP	92505
Phone	951 324-8100
CertificateType	4
CertificateEffectiveDate	12/24/2023
CertificateExpirationDate	12/23/2025
FacilityType	Waiver

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