05D1071115 CLIA NUMBER - FRAULINE DRIVE

Laboratory Demographics

  • CLIA Code: 05D1071115
  • Facility Name: FRAULINE DRIVE
  • Facility Address: 1384 FRAULINE DRIVE
    SAN DIEGO, CA
    ZIP 92154
  • Facility Phone: 619 575-2824
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: LEON R. KELLEY
  • NPI Number: 1528250024
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D1071115
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name FRAULINE DRIVE
Street 1384 FRAULINE DRIVE
City SAN DIEGO
State CA
ZIP 92154
Phone 619 575-2824
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director LEON R. KELLEY

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