05D1056826 CLIA NUMBER - SAN DIEGO PEDIATRICS & FAMILY MEDICAL CLINIC, INC

Laboratory Demographics

CLIA Number: 05D1056826

Facility Name: SAN DIEGO PEDIATRICS & FAMILY MEDICAL CLINIC, INC

Facility Address:
401 H STREET, SUITE 3
CHULA VISTA, CA
ZIP 91910
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Facility Phone Number: 619 691-0001

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265443444

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D1056826
LAB Type	Physician Office
Facility Name	SAN DIEGO PEDIATRICS & FAMILY MEDICAL CLINIC, INC
Street	401 H STREET, SUITE 3
City	CHULA VISTA
State	CA
ZIP	91910
Phone	619 691-0001
CertificateType	4
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Waiver

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