05D1081284 CLIA NUMBER - ST ISABEL FAMILY MEDICAL CLINIC INC

Laboratory Demographics

CLIA Number: 05D1081284

Facility Name: ST ISABEL FAMILY MEDICAL CLINIC INC

Facility Address:
1535 W LOMITA BLVD
HARBOR CITY, CA
ZIP 90710
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Facility Phone Number: 310 530-9300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700057981

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1081284
LAB Type	Physician Office
Facility Name	ST ISABEL FAMILY MEDICAL CLINIC INC
Street	1535 W LOMITA BLVD
City	HARBOR CITY
State	CA
ZIP	90710
Phone	310 530-9300
CertificateType	4
CertificateEffectiveDate	6/22/2022
CertificateExpirationDate	6/21/2024
FacilityType	Waiver

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