05D1078439 CLIA NUMBER - CONCENTRA-ONTARIO

Laboratory Demographics

CLIA Number: 05D1078439

Facility Name: CONCENTRA-ONTARIO

Facility Address:
1101 S MILLIKEN AVE STE C
ONTARIO, CA
ZIP 91761
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Facility Phone Number: 909 390-2799

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659551695

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1078439
LAB Type	Physician Office
Facility Name	CONCENTRA-ONTARIO
Street	1101 S MILLIKEN AVE STE C
City	ONTARIO
State	CA
ZIP	91761
Phone	909 390-2799
CertificateType	4
CertificateEffectiveDate	1/9/2024
CertificateExpirationDate	1/8/2026
FacilityType	Waiver

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