05D1072094 CLIA NUMBER - SHALOM MEDICAL CLINIC INC

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Laboratory Demographics

CLIA Number: 05D1072094

Facility Name: SHALOM MEDICAL CLINIC INC

Facility Address:
1721 N WILMINGTON BLVD
WILMINGTON, CA
ZIP 90744
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Facility Phone Number: 310 835-1414

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295940054

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D1072094
LAB Type	Physician Office
Facility Name	SHALOM MEDICAL CLINIC INC
Street	1721 N WILMINGTON BLVD
City	WILMINGTON
State	CA
ZIP	90744
Phone	310 835-1414
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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