05D1044705 CLIA NUMBER - SAN DIEGO HEALTH ALLIANCE, INC DBA FASHION VALLEY CLINIC

Laboratory Demographics

CLIA Number: 05D1044705

Facility Name: SAN DIEGO HEALTH ALLIANCE, INC DBA FASHION VALLEY CLINIC

Facility Address:
7545 METROPOLITAN DR
SAN DIEGO, CA
ZIP 92108
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Facility Phone Number: 619 718-9890

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1700989829

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	05D1044705
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	SAN DIEGO HEALTH ALLIANCE, INC DBA FASHION VALLEY CLINIC
Street	7545 METROPOLITAN DR
City	SAN DIEGO
State	CA
ZIP	92108
Phone	619 718-9890
CertificateType	4
CertificateEffectiveDate	8/25/2023
CertificateExpirationDate	8/24/2025
FacilityType	Waiver

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