05D1014199 CLIA NUMBER - SOUTHERN ORANGE COUNTY PEDIATRICS ASSOC

Laboratory Demographics

CLIA Number: 05D1014199

Facility Name: SOUTHERN ORANGE COUNTY PEDIATRICS ASSOC

Facility Address:
777 CORPORATE DRIVE SUITE 250
LADERA RANCH, CA
ZIP 92694
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Facility Phone Number: 949 388-1798

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619396884

Taxonomy: 213ES0103X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	05D1014199
LAB Type	Physician Office
Facility Name	SOUTHERN ORANGE COUNTY PEDIATRICS ASSOC
Street	777 CORPORATE DRIVE SUITE 250
City	LADERA RANCH
State	CA
ZIP	92694
Phone	949 388-1798
CertificateType	4
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	Waiver

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