05D1049094 CLIA NUMBER - SAN ANTONIO COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D1049094

Facility Name: SAN ANTONIO COMMUNITY HEALTH CENTER

Facility Address:
2286 S GAREY AVE
POMONA, CA
ZIP 91766
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Facility Phone Number: 909 464-2817

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1265829766

Taxonomy: 363AM0700X - Physician Assistant

CLIA Record

Field Name	Field Value
CLIA Number	05D1049094
LAB Type	Community Clinic
Facility Name	SAN ANTONIO COMMUNITY HEALTH CENTER
Street	2286 S GAREY AVE
City	POMONA
State	CA
ZIP	91766
Phone	909 464-2817
CertificateType	4
CertificateEffectiveDate	12/22/2023
CertificateExpirationDate	12/21/2025
FacilityType	Waiver

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