05D1074128 CLIA NUMBER - MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIF INC

Laboratory Demographics

CLIA Number: 05D1074128

Facility Name: MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIF INC

Facility Address:
19353 VICTORY BLVD
RESEDA, CA
ZIP 91335
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Facility Phone Number: 866 389-2727

Facility Type: Other - LIMITED SERVICE HEALTH

Certificate Type: Waiver

NPI Number: 1033309372

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	05D1074128
LAB Type	Other - LIMITED SERVICE HEALTH
Facility Name	MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF CALIF INC
Street	19353 VICTORY BLVD
City	RESEDA
State	CA
ZIP	91335
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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