05D1000003 CLIA NUMBER - PACIFIC RIDGE MEDICAL ASSOCIATES, INC

Laboratory Demographics

CLIA Number: 05D1000003

Facility Name: PACIFIC RIDGE MEDICAL ASSOCIATES, INC

Facility Address:
25401 CABOT ROAD SUITE 101
LAGUNA HILLS, CA
ZIP 92653
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Facility Phone Number: 949 768-4850

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114089257

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1000003
LAB Type	Physician Office
Facility Name	PACIFIC RIDGE MEDICAL ASSOCIATES, INC
Street	25401 CABOT ROAD SUITE 101
City	LAGUNA HILLS
State	CA
ZIP	92653
Phone	949 768-4850
CertificateType	4
CertificateEffectiveDate	5/30/2022
CertificateExpirationDate	5/29/2024
FacilityType	Waiver

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