05D1051694 CLIA NUMBER - BEAVER ADVANTAGE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D1051694
  • Facility Name: BEAVER ADVANTAGE HEALTH CENTER
  • Facility Address: 1600 E CITRUS AVE
    REDLANDS, CA
    ZIP 92374
  • Facility Phone: 909 786-0844
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Microscopy
  • Lab Director: MICHAEL WILSON
  • NPI Number: 1275570830
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1051694
LAB Type Ancillary Testing Site in Health Care Center
Facility Name BEAVER ADVANTAGE HEALTH CENTER
Street 1600 E CITRUS AVE
City REDLANDS
State CA
ZIP 92374
Phone 909 786-0844
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director MICHAEL WILSON

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This page was last updated on: 9/29/2025