05D1066363 CLIA NUMBER - SAN DIEGO IMAGING KEARNY MESA LLC

Laboratory Demographics

CLIA Number: 05D1066363

Facility Name: SAN DIEGO IMAGING KEARNY MESA LLC

Facility Address:
7910 FROST ST STE 100
SAN DIEGO, CA
ZIP 92123
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Facility Phone Number: 858 634-5900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043378136

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1066363
LAB Type	Physician Office
Facility Name	SAN DIEGO IMAGING KEARNY MESA LLC
Street	7910 FROST ST STE 100
City	SAN DIEGO
State	CA
ZIP	92123
Phone	858 634-5900
CertificateType	4
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Waiver

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