05D1033050 CLIA NUMBER - ALTERNATE AVENUES WOMEN'S RESOURCE CENTER

Laboratory Demographics

CLIA Number: 05D1033050

Facility Name: ALTERNATE AVENUES WOMEN'S RESOURCE CENTER

Facility Address:
17057 FOOTHILL BLVD, STE 204
FONTANA, CA
ZIP 92335
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Facility Phone Number: 909 621-4800

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1669529863

Taxonomy: 251V00000X - Voluntary or Charitable

CLIA Record

Field Name	Field Value
CLIA Number	05D1033050
LAB Type	Community Clinic
Facility Name	ALTERNATE AVENUES WOMEN'S RESOURCE CENTER
Street	17057 FOOTHILL BLVD, STE 204
City	FONTANA
State	CA
ZIP	92335
Phone	909 621-4800
CertificateType	4
CertificateEffectiveDate	11/3/2022
CertificateExpirationDate	11/2/2024
FacilityType	Waiver

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