05D1063024 CLIA NUMBER - MENIFEE GLOBAL MULTI SPECIALTY GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1063024
  • Facility Name: MENIFEE GLOBAL MULTI SPECIALTY GROUP INC
  • Facility Address: 850 E LATHAM AVE STE 205
    HEMET, CA
    ZIP 92543
  • Facility Phone: 951 658-7205
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VEERAVAT S. TAECHARVONGPHAIROJ
  • NPI Number: 1568473106
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1063024
LAB Type Physician Office
Facility Name MENIFEE GLOBAL MULTI SPECIALTY GROUP INC
Street 850 E LATHAM AVE STE 205
City HEMET
State CA
ZIP 92543
Phone 951 658-7205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Physician Office
Lab Director VEERAVAT S. TAECHARVONGPHAIROJ

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