05D1077520 CLIA NUMBER - PARK SIERRA MEDICAL CLINIC, INC

Laboratory Demographics

CLIA Number: 05D1077520

Facility Name: PARK SIERRA MEDICAL CLINIC, INC

Facility Address:
1023 SOUTH MOUNT VERNON AVENUE SUITE N3
COLTON, CA
ZIP 92324
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Facility Phone Number: 909 533-4443

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184833428

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D1077520
LAB Type	Physician Office
Facility Name	PARK SIERRA MEDICAL CLINIC, INC
Street	1023 SOUTH MOUNT VERNON AVENUE SUITE N3
City	COLTON
State	CA
ZIP	92324
Phone	909 533-4443
CertificateType	4
CertificateEffectiveDate	1/13/2024
CertificateExpirationDate	1/12/2026
FacilityType	Waiver

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