05D1074958 CLIA NUMBER - VICTOR VALLEY PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 05D1074958
  • Facility Name: VICTOR VALLEY PRIMARY CARE INC
  • Facility Address: 16125 KAMANA RD
    APPLE VALLEY, CA
    ZIP 92307
  • Facility Phone: 760 946-2600
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ALDEN I. JALLORINA MD
  • NPI Number: 1487823985
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1074958
LAB Type Physician Office
Facility Name VICTOR VALLEY PRIMARY CARE INC
Street 16125 KAMANA RD
City APPLE VALLEY
State CA
ZIP 92307
Phone 760 946-2600
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/10/2025
Certificate Expiration Date 10/9/2027
Facility Type Physician Office
Lab Director ALDEN I. JALLORINA MD

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