05D1083867 CLIA NUMBER - SAN DIEGO MIRAMAR COLLEGE STUDENT HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 05D1083867
  • Facility Name: SAN DIEGO MIRAMAR COLLEGE STUDENT HEALTH SERVICES
  • Facility Address: 10440 BLACK MTN RD BLDG K2-102
    SAN DIEGO, CA
    ZIP 92126
  • Facility Phone: 858 536-7881
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: CALVIN K. WONG MD
  • NPI Number: 1528176674
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D1083867
LAB Type School/Student Health Service
Facility Name SAN DIEGO MIRAMAR COLLEGE STUDENT HEALTH SERVICES
Street 10440 BLACK MTN RD BLDG K2-102
City SAN DIEGO
State CA
ZIP 92126
Phone 858 536-7881
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type School/Student Health Service
Lab Director CALVIN K. WONG MD

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