05D0998531 CLIA NUMBER - CONCENTRA - ONTARIO SOUTH (GROVE)

Laboratory Demographics

  • CLIA Code: 05D0998531
  • Facility Name: CONCENTRA - ONTARIO SOUTH (GROVE)
  • Facility Address: 2171 S GROVE AVENUE SUITE A
    ONTARIO, CA
    ZIP 91761
  • Facility Phone: 909 923-4080
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEITH WRESCH
  • NPI Number: 1609025774
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0998531
LAB Type Physician Office
Facility Name CONCENTRA - ONTARIO SOUTH (GROVE)
Street 2171 S GROVE AVENUE SUITE A
City ONTARIO
State CA
ZIP 91761
Phone 909 923-4080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Physician Office
Lab Director KEITH WRESCH

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