05D1078443 CLIA NUMBER - LAS PALMAS MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D1078443

Facility Name: LAS PALMAS MEDICAL CLINIC

Facility Address:
527 N PALM AVE STE 106
ONTARIO, CA
ZIP 91762
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Facility Phone Number: 909 391-3423

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013214568

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D1078443
LAB Type	Physician Office
Facility Name	LAS PALMAS MEDICAL CLINIC
Street	527 N PALM AVE STE 106
City	ONTARIO
State	CA
ZIP	91762
Phone	909 391-3423
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