05D1012436 CLIA NUMBER - GROSSMAN IMAGING OF CMH, LLC

Laboratory Demographics

CLIA Number: 05D1012436

Facility Name: GROSSMAN IMAGING OF CMH, LLC

Facility Address:
2001 NORTH SOLAR DRIVE SUITE #135
OXNARD, CA
ZIP 93036
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Facility Phone Number: 805 988-0616

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366463572

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	05D1012436
LAB Type	Physician Office
Facility Name	GROSSMAN IMAGING OF CMH, LLC
Street	2001 NORTH SOLAR DRIVE SUITE #135
City	OXNARD
State	CA
ZIP	93036
Phone	805 988-0616
CertificateType	4
CertificateEffectiveDate	9/1/2023
CertificateExpirationDate	8/31/2025
FacilityType	Waiver

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