05D1048748 CLIA NUMBER - SAN DIEGO FAMILY CARE MID CITY COMMUNITY CLINIC HIV TESTING

Laboratory Demographics

  • CLIA Code: 05D1048748
  • Facility Name: SAN DIEGO FAMILY CARE MID CITY COMMUNITY CLINIC HIV TESTING
  • Facility Address: 4290 POLK AVE
    SAN DIEGO, CA
    ZIP 92105
  • Facility Phone: 619 563-0250
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DIANA MARQUARDT
  • NPI Number: 1245472414
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 05D1048748
LAB Type Community Clinic
Facility Name SAN DIEGO FAMILY CARE MID CITY COMMUNITY CLINIC HIV TESTING
Street 4290 POLK AVE
City SAN DIEGO
State CA
ZIP 92105
Phone 619 563-0250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Community Clinic
Lab Director DIANA MARQUARDT

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This page was last updated on: 6/4/2025