05D0999837 CLIA NUMBER - MAGNOLIA ADHC

Laboratory Demographics

  • CLIA Code: 05D0999837
  • Facility Name: MAGNOLIA ADHC
  • Facility Address: 490 N MAGNOLIA AVE
    EL CAJON, CA
    ZIP 92020
  • Facility Phone: 619 444-1522
  • Facility Type: Other - CBAS (ADHC)
  • Facility Type: Waiver
  • Lab Director: DAVID MANSOUR
  • NPI Number: 1063887875
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0999837
LAB Type Other - CBAS (ADHC)
Facility Name MAGNOLIA ADHC
Street 490 N MAGNOLIA AVE
City EL CAJON
State CA
ZIP 92020
Phone 619 444-1522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Other - CBAS (ADHC)
Lab Director DAVID MANSOUR

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