05D0997660 CLIA NUMBER - PACIFIC HORIZON MEDICAL CENTER, INC

Laboratory Demographics

CLIA Number: 05D0997660

Facility Name: PACIFIC HORIZON MEDICAL CENTER, INC

Facility Address:
316 E LAS TUNAS DR STE 102
SAN GABRIEL, CA
ZIP 91776
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Facility Phone Number: 626 300-8880

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285826669

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D0997660
LAB Type	Physician Office
Facility Name	PACIFIC HORIZON MEDICAL CENTER, INC
Street	316 E LAS TUNAS DR STE 102
City	SAN GABRIEL
State	CA
ZIP	91776
Phone	626 300-8880
CertificateType	4
CertificateEffectiveDate	3/22/2024
CertificateExpirationDate	3/21/2026
FacilityType	Waiver

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