05D1060329 CLIA NUMBER - SU CLINICA MEDICA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D1060329
  • Facility Name: SU CLINICA MEDICA MEDICAL GROUP
  • Facility Address: 850 W HIGHLAND AVE STE A
    SAN BERNARDINO, CA
    ZIP 92405
  • Facility Phone: 909 886-7576
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: JOSE A. DE LA LLANA, MD
  • NPI Number: 1235589086
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D1060329
LAB Type Community Clinic
Facility Name SU CLINICA MEDICA MEDICAL GROUP
Street 850 W HIGHLAND AVE STE A
City SAN BERNARDINO
State CA
ZIP 92405
Phone 909 886-7576
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2024
Certificate Expiration Date 10/19/2026
Facility Type Community Clinic
Lab Director JOSE A. DE LA LLANA, MD

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This page was last updated on: 3/20/2025