05D1054815 CLIA NUMBER - WALSH MEDICAL GROUP, INC

Laboratory Demographics

CLIA Number: 05D1054815

Facility Name: WALSH MEDICAL GROUP, INC

Facility Address:
1110 W LA PALMA AVE, SUITE 6
ANAHEIM, CA
ZIP 92801
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Facility Phone Number: 714 502-1144

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407021421

Taxonomy: 305S00000X - Point of Service
This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.

CLIA Record

Field Name	Field Value
CLIA Number	05D1054815
LAB Type	Physician Office
Facility Name	WALSH MEDICAL GROUP, INC
Street	1110 W LA PALMA AVE, SUITE 6
City	ANAHEIM
State	CA
ZIP	92801
Phone	714 502-1144
CertificateType	4
CertificateEffectiveDate	5/31/2022
CertificateExpirationDate	5/30/2024
FacilityType	Waiver

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