05D1042496 CLIA NUMBER - ELISSA GROPEN DERMATOLOGY, INC

Laboratory Demographics

CLIA Number: 05D1042496

Facility Name: ELISSA GROPEN DERMATOLOGY, INC

Facility Address:
3576 ARLINGTON AVE, STE 102
RIVERSIDE, CA
ZIP 92506
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Facility Phone Number: 951 684-8397

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1700949112

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D1042496
LAB Type	Physician Office
Facility Name	ELISSA GROPEN DERMATOLOGY, INC
Street	3576 ARLINGTON AVE, STE 102
City	RIVERSIDE
State	CA
ZIP	92506
Phone	951 684-8397
CertificateType	3
CertificateEffectiveDate	1/1/2024
CertificateExpirationDate	12/31/2025
FacilityType	PPMP

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